Provider Demographics
NPI:1528001757
Name:PRENTICE, JAN FRAZIER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JAN
Middle Name:FRAZIER
Last Name:PRENTICE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:7132 CALABRIA COURT
Mailing Address - Street 2:#B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5584
Mailing Address - Country:US
Mailing Address - Phone:858-587-2501
Mailing Address - Fax:858-587-0395
Practice Address - Street 1:VA SAN DIEGO HEALTHCARE SYSTEM
Practice Address - Street 2:3350 LA JOLLA VILLAGE DRIVE #128
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-552-4315
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10839363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant