Provider Demographics
NPI:1790876381
Name:ECKERMAN, JENNIFER (PA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:ECKERMAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3599 SUELDO ST
Mailing Address - Street 2:110
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7329
Mailing Address - Country:US
Mailing Address - Phone:805-786-2500
Mailing Address - Fax:805-781-0423
Practice Address - Street 1:1310 LAS TABLAS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9737
Practice Address - Country:US
Practice Address - Phone:805-786-2500
Practice Address - Fax:805-781-0423
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA17024363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW7179Medicare PIN