Provider Demographics
NPI:1801051826
Name:SURGENER, JENNIFER RACHAEL (FNP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:RACHAEL
Last Name:SURGENER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RACHAEL
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14642 NEWPORT AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6057
Mailing Address - Country:US
Mailing Address - Phone:714-669-4466
Mailing Address - Fax:714-669-4088
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6057
Practice Address - Country:US
Practice Address - Phone:714-669-4466
Practice Address - Fax:714-669-4088
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15194363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily