Provider Demographics
NPI:1053660332
Name:CLANCY, JEAN S (ANP, RN, MSN)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:S
Last Name:CLANCY
Suffix:
Gender:F
Credentials:ANP, RN, MSN
Other - Prefix:MRS
Other - First Name:JEAN
Other - Middle Name:S
Other - Last Name:FRIZZELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP, RN, MSN
Mailing Address - Street 1:3101 CALLE CEDRO
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2782
Mailing Address - Country:US
Mailing Address - Phone:805-569-5219
Mailing Address - Fax:
Practice Address - Street 1:3101 CALLE CEDRO
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-2782
Practice Address - Country:US
Practice Address - Phone:805-569-5219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA413194363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health