Provider Demographics
NPI:1801070933
Name:MOORE, JENNIFER NISHKIAN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NISHKIAN
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:13095 JAMBOREE RD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-9150
Mailing Address - Country:US
Mailing Address - Phone:714-838-8254
Mailing Address - Fax:714-838-9463
Practice Address - Street 1:13095 JAMBOREE RD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-9150
Practice Address - Country:US
Practice Address - Phone:714-838-8254
Practice Address - Fax:714-838-9463
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2012-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA19486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant