Provider Demographics
NPI:1346786019
Name:NELSEN, JENNIFER (AGACNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:NELSEN
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 W ROBIN AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8069
Mailing Address - Country:US
Mailing Address - Phone:559-799-5598
Mailing Address - Fax:
Practice Address - Street 1:36650 ROAD 112
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-9517
Practice Address - Country:US
Practice Address - Phone:559-735-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005804363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner