Provider Demographics
NPI:1619001104
Name:JANSEN, CINDY B (CNP)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:B
Last Name:JANSEN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 BARRANCA PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-8603
Mailing Address - Country:US
Mailing Address - Phone:949-726-0600
Mailing Address - Fax:
Practice Address - Street 1:4900 BARRANCA PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8603
Practice Address - Country:US
Practice Address - Phone:949-726-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1224363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner