Provider Demographics
NPI:1275193328
Name:MAGNOTTI, JODI LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:MAGNOTTI
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:LYNN
Other - Last Name:ZUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6939 N PUSCH PEAK PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1319
Mailing Address - Country:US
Mailing Address - Phone:901-590-5093
Mailing Address - Fax:
Practice Address - Street 1:535 N WILMOT RD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2629
Practice Address - Country:US
Practice Address - Phone:520-694-1234
Practice Address - Fax:520-694-2185
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-19
Last Update Date:2025-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ297136363LF0000X
TN26024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN26024Medicaid