Provider Demographics
NPI:1497953053
Name:HAHN, NICOLE JANETTE (PA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JANETTE
Last Name:HAHN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JANETTE
Other - Middle Name:NICOLE
Other - Last Name:CAIAZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:739 CALLE BAHIA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24012 CALLE DE LA PLATA STE 200
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7624
Practice Address - Country:US
Practice Address - Phone:926-914-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011873363A00000X
CA20893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant