Provider Demographics
NPI:1508122755
Name:LAGANA, JACQUELINE XS (CNM, WHNP)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:XS
Last Name:LAGANA
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2729 S 1000 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-2241
Mailing Address - Country:US
Mailing Address - Phone:801-953-4320
Mailing Address - Fax:
Practice Address - Street 1:518 GARDEN ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101
Practice Address - Country:US
Practice Address - Phone:805-963-2445
Practice Address - Fax:805-965-2292
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO367A00000X
CA95009305363LW0102X
FL9458470367A00000X
UT7022075-4402367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95009305OtherNURSE PRACTITIONER