Provider Demographics
NPI:1568804326
Name:BYRNE, JENNIFER MARY (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARY
Last Name:BYRNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:UC HEALTH SYSTEM MOORES CANCER CTR
Practice Address - Street 2:3855HEALTH SCIENCES DRIVE, #0960
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0960
Practice Address - Country:US
Practice Address - Phone:858-822-6390
Practice Address - Fax:858-822-6395
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4006364S00000X
CA23295363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist