Provider Demographics
NPI:1578816633
Name:WRIGHT, JENNIFER NICHOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICHOLE
Other - Last Name:BLACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-795-3600
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:124 S A ST
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-3619
Practice Address - Country:US
Practice Address - Phone:559-664-4000
Practice Address - Fax:559-675-5661
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22468363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant