Provider Demographics
NPI:1174179113
Name:BUCKLEY, JENNIFER ANNE HAGLER (RN, MSN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE HAGLER
Last Name:BUCKLEY
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOCO DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-2474
Mailing Address - Country:US
Mailing Address - Phone:831-235-2211
Mailing Address - Fax:
Practice Address - Street 1:5450 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3522
Practice Address - Country:US
Practice Address - Phone:909-219-9804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95012102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily