Provider Demographics
NPI:1720518772
Name:SMITH, JUALYNDA CAROL (FNP-C)
Entity Type:Individual
Prefix:
First Name:JUALYNDA
Middle Name:CAROL
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12301 WILSHIRE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1023
Mailing Address - Country:US
Mailing Address - Phone:310-828-2293
Mailing Address - Fax:310-453-3759
Practice Address - Street 1:12301 WILSHIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1023
Practice Address - Country:US
Practice Address - Phone:310-828-2293
Practice Address - Fax:310-453-3759
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006415363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily