Provider Demographics
NPI:1558862458
Name:KIRK, JENNIFER E (ACNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:KIRK
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3828 SCHAUFELE AVENUE, STE 340
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808
Mailing Address - Country:US
Mailing Address - Phone:657-241-9052
Mailing Address - Fax:714-665-4663
Practice Address - Street 1:3828 SCHAUFELE AVENUE, STE 340
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808
Practice Address - Country:US
Practice Address - Phone:657-241-9052
Practice Address - Fax:714-665-4663
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95008639363L00000X
CA95008639363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner