Provider Demographics
NPI:1073282786
Name:ZOMMICK, JACQUELYN VICTORIA (PMHNP)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:VICTORIA
Last Name:ZOMMICK
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28212 KELLY JOHNSON PKWY STE 215
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-5090
Mailing Address - Country:US
Mailing Address - Phone:818-688-6826
Mailing Address - Fax:
Practice Address - Street 1:28212 KELLY JOHNSON PKWY STE 215
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-5090
Practice Address - Country:US
Practice Address - Phone:818-688-6826
Practice Address - Fax:877-349-4481
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020736363LP0808X, 363LP0808X
FL11019165363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health