Individual
JENNIFER TA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
338 S DAKOTA AVE BLDG 13850, LOMPOC, CA 93437-6307
(805) 606-2273
Mailing address
338 S DAKOTA AVE, LOMPOC, CA 93437-6307
(805) 605-1301
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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