Provider Demographics
NPI:1073542262
Name:O'HERIN, JENNIFER LYN (PA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:O'HERIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14322 SHADYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6345
Mailing Address - Country:US
Mailing Address - Phone:714-508-9042
Mailing Address - Fax:
Practice Address - Street 1:1619 E EDINGER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5001
Practice Address - Country:US
Practice Address - Phone:714-542-8904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12411363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical