Provider Demographics
NPI:1588003487
Name:BRONSON, JENNIFER GABRIELLE (ACNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GABRIELLE
Last Name:BRONSON
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 1:29826 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:CASTAIC
Mailing Address - State:CA
Mailing Address - Zip Code:91384-4535
Mailing Address - Country:US
Mailing Address - Phone:818-317-4922
Mailing Address - Fax:
Practice Address - Street 1:18350 ROSCOE BLVD
Practice Address - Street 2:213
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4109
Practice Address - Country:US
Practice Address - Phone:818-718-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21312363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care