Provider Demographics
NPI:1154906782
Name:SCHENK, JORDAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:SCHENK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11685 W MASSINGALE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-9408
Mailing Address - Country:US
Mailing Address - Phone:208-709-6462
Mailing Address - Fax:
Practice Address - Street 1:202 E EARLL DR STE 360
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2677
Practice Address - Country:US
Practice Address - Phone:480-788-5621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8407363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant