Provider Demographics
NPI:1568802775
Name:JUMP, JACKLYN (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:JACKLYN
Middle Name:
Last Name:JUMP
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1050
Mailing Address - Country:US
Mailing Address - Phone:818-241-3125
Mailing Address - Fax:
Practice Address - Street 1:1080 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2310
Practice Address - Country:US
Practice Address - Phone:323-957-8787
Practice Address - Fax:323-957-8777
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily