Provider Demographics
NPI:1144902891
Name:NARANJO, JESICA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JESICA
Middle Name:
Last Name:NARANJO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 E 5900 S STE B109
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7293
Mailing Address - Country:US
Mailing Address - Phone:385-275-4673
Mailing Address - Fax:801-999-4166
Practice Address - Street 1:166 E 5900 S STE B109
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7293
Practice Address - Country:US
Practice Address - Phone:801-706-5506
Practice Address - Fax:801-999-4166
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10826953-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner