Provider Demographics
NPI:1073947362
Name:NEGLEY, JOELLE NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:JOELLE
Middle Name:NICOLE
Last Name:NEGLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOELLE
Other - Middle Name:NICOLE
Other - Last Name:BITTNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:9610 GRANITE RIDGE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2684
Mailing Address - Country:US
Mailing Address - Phone:858-810-8000
Mailing Address - Fax:858-268-1911
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:SUITE 505
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3017
Practice Address - Country:US
Practice Address - Phone:619-461-3880
Practice Address - Fax:619-461-3895
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52553363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA164893OtherSO. CALIFORNIA PTAN