Provider Demographics
NPI:1619671377
Name:MAGNO, JOANA LYNN VICENCIO (FNP)
Entity Type:Individual
Prefix:
First Name:JOANA LYNN
Middle Name:VICENCIO
Last Name:MAGNO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 FAIRMOUNT AVE APT 136
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3599
Mailing Address - Country:US
Mailing Address - Phone:619-739-1574
Mailing Address - Fax:
Practice Address - Street 1:6161 FAIRMOUNT AVE APT 136
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3599
Practice Address - Country:US
Practice Address - Phone:619-739-1574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily