Provider Demographics
NPI:1205648219
Name:JARVIS, NICHOLAS GEORGE (FNP-C)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GEORGE
Last Name:JARVIS
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:GEORGE
Other - Last Name:JARVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1636 N 3100 W
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-9494
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 N MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1272
Practice Address - Country:US
Practice Address - Phone:801-876-3749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-25
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11422131-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily