Provider Demographics
NPI:1629457403
Name:HAMBLIN, JENNIFER (MMS, PA-C, ATC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HAMBLIN
Suffix:
Gender:F
Credentials:MMS, PA-C, ATC
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PRATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:300 S PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4124
Mailing Address - Country:US
Mailing Address - Phone:619-334-4869
Mailing Address - Fax:
Practice Address - Street 1:300 S PIERCE ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4124
Practice Address - Country:US
Practice Address - Phone:619-334-4869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant