Provider Demographics
NPI:1437434693
Name:AGUILA, JENNIFER VERGARA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:VERGARA
Last Name:AGUILA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7240 E YALE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93737-0007
Mailing Address - Country:US
Mailing Address - Phone:904-654-8725
Mailing Address - Fax:
Practice Address - Street 1:951 MARINERS ISLAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94404-1560
Practice Address - Country:US
Practice Address - Phone:772-217-4557
Practice Address - Fax:888-352-7383
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily