Provider Demographics
NPI:1902120033
Name:BERNAL, JENNIFER M (CSFA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:BERNAL
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 W COMBS RD STE 101-201
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-9123
Mailing Address - Country:US
Mailing Address - Phone:480-209-8526
Mailing Address - Fax:
Practice Address - Street 1:85 W COMBS RD STE 101-201
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-9123
Practice Address - Country:US
Practice Address - Phone:480-209-8526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-18
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical