Provider Demographics
NPI:1477357713
Name:SALAS, JACQUELYNNE KRISTY ROBLES (FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:JACQUELYNNE KRISTY
Middle Name:ROBLES
Last Name:SALAS
Suffix:
Gender:
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 E GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2844
Mailing Address - Country:US
Mailing Address - Phone:949-293-1684
Mailing Address - Fax:
Practice Address - Street 1:828 E GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-2844
Practice Address - Country:US
Practice Address - Phone:949-293-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2025021554363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty