Provider Demographics
NPI:1386883551
Name:FALTINOWSKI, JESSICA RAE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RAE
Last Name:FALTINOWSKI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4111 E VALLEY AUTO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4609
Mailing Address - Country:US
Mailing Address - Phone:480-999-2954
Mailing Address - Fax:480-999-2964
Practice Address - Street 1:4111 E VALLEY AUTO DR STE 201
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4609
Practice Address - Country:US
Practice Address - Phone:480-999-2954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ226478363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health