Provider Demographics
NPI:1073583985
Name:COTTEN, JACQUELINE MARIA (CFNP/CPNP)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MARIA
Last Name:COTTEN
Suffix:
Gender:F
Credentials:CFNP/CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 NOREEN PL
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-3850
Mailing Address - Country:US
Mailing Address - Phone:760-721-2863
Mailing Address - Fax:760-945-3201
Practice Address - Street 1:2122 S EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6209
Practice Address - Country:US
Practice Address - Phone:760-754-0974
Practice Address - Fax:760-945-3201
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349415363LF0000X
CA4346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4346OtherNURSE PRACTITIONER