Individual
BERNICE JANA JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
17612 17TH ST, TUSTIN, CA 92780-1962
(714) 243-5450
Mailing address
914 HIBISCUS WAY, PLACENTIA, CA 92870-4716
(714) 422-7732
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95005613
CA
Other
Enumeration date
01/04/2017
Last updated
01/04/2017
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