Provider Demographics
NPI:1356826994
Name:AGUIRRE, NANCY JEANETTE (FNP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JEANETTE
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JEANETTE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:981 W ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2410
Mailing Address - Country:US
Mailing Address - Phone:323-737-5200
Mailing Address - Fax:
Practice Address - Street 1:1655 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-5801
Practice Address - Country:US
Practice Address - Phone:323-715-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-29
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner