Individual
MR. JERRICK THACKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN APRN FNP-C
Contact information
Practice address
13024 HESPERIA RD, VICTORVILLE, CA 92395-8302
(760) 241-3547
Mailing address
13024 HESPERIA RD. SUIT 103, VICTORVILLE, CA 92395
(760) 241-3547
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95020352
CA
Other
Enumeration date
04/09/2022
Last updated
04/25/2022
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