Individual
JENNIFER TA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
19921
CA
363LP2300X
Primary Care Nurse Practitioner
19921
CA
Other
Enumeration date
09/13/2012
Last updated
03/30/2020
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