Provider Demographics
NPI:1295436004
Name:SMITH, JAYLYNN BROZELL (RN)
Entity type:Individual
Prefix:
First Name:JAYLYNN
Middle Name:BROZELL
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YELLOW ROSE CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3485
Mailing Address - Country:US
Mailing Address - Phone:510-697-7033
Mailing Address - Fax:
Practice Address - Street 1:2122 YELLOW ROSE CIR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-3485
Practice Address - Country:US
Practice Address - Phone:510-697-7033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA820748163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management