Provider Demographics
NPI:1235506536
Name:CHOW, CAROL JACQUELYN (FNP-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JACQUELYN
Last Name:CHOW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 TURN LEAF
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0134
Mailing Address - Country:US
Mailing Address - Phone:949-500-5206
Mailing Address - Fax:
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:BUILDING 41, 3RD FLOOR
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-5350
Practice Address - Fax:949-764-5607
Is Sole Proprietor?:No
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily