Provider Demographics
NPI:1689986168
Name:ROBINSON, JENELLE NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENELLE
Middle Name:NICOLE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 FOURTH AVE STE 7A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-3813
Mailing Address - Country:US
Mailing Address - Phone:619-691-0388
Mailing Address - Fax:619-691-0387
Practice Address - Street 1:340 FOURTH AVE STE 7A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-3813
Practice Address - Country:US
Practice Address - Phone:619-691-0388
Practice Address - Fax:619-691-0387
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 06619363AM0700X
CAPA52293363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical