Provider Demographics
NPI:1629443262
Name:HERNDON, JIENELLE SAGUM (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JIENELLE
Middle Name:SAGUM
Last Name:HERNDON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NUT TREE RD STE 310
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-4686
Mailing Address - Country:US
Mailing Address - Phone:707-359-1800
Mailing Address - Fax:
Practice Address - Street 1:600 NUT TREE RD STE 310
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-4686
Practice Address - Country:US
Practice Address - Phone:707-359-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-08
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003516363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily