Provider Demographics
NPI:1346047339
Name:VINATIERI, JADE MARIE (FNP-BC)
Entity type:Individual
Prefix:MS
First Name:JADE
Middle Name:MARIE
Last Name:VINATIERI
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5210 N VALLE DORADO
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-1599
Mailing Address - Country:US
Mailing Address - Phone:928-530-9783
Mailing Address - Fax:
Practice Address - Street 1:2091 SMOKETREE AVE N STE 103
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5896
Practice Address - Country:US
Practice Address - Phone:928-453-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ267114207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology