Provider Demographics
NPI:1346259611
Name:FERNANDO, JENNIFER P (RNPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:FERNANDO
Suffix:
Gender:F
Credentials:RNPC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:P
Other - Last Name:FERNANDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNPC
Mailing Address - Street 1:1241. E. DYER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-978-4532
Mailing Address - Fax:
Practice Address - Street 1:23181 VERDUGO DR STE 103A
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1313
Practice Address - Country:US
Practice Address - Phone:949-366-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN483580363L00000X, 363LX0001X
CANP7343363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN483580Medicaid
CARN483580Medicaid
P13562Medicare UPIN