Provider Demographics
NPI:1225376197
Name:SOUSA, JALYNNE NONE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JALYNNE
Middle Name:NONE
Last Name:SOUSA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2562 MARSHFIELD ROAD
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592-1189
Mailing Address - Country:US
Mailing Address - Phone:707-683-5220
Mailing Address - Fax:
Practice Address - Street 1:3431 BROADWAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94592-1189
Practice Address - Country:US
Practice Address - Phone:707-683-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily