Provider Demographics
NPI:1972064558
Name:DE LA GARZA, JENNIFER DENISE (ACNPC-NG)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DENISE
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:ACNPC-NG
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:D
Other - Last Name:WESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNPC-NG
Mailing Address - Street 1:16453 N 150TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-1472
Mailing Address - Country:US
Mailing Address - Phone:623-313-2347
Mailing Address - Fax:
Practice Address - Street 1:287 E HUNT HWY STE 105
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5096
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ224060363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care