Provider Demographics
NPI:1982924684
Name:JAYE, LYSSA MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:LYSSA
Middle Name:MICHELLE
Last Name:JAYE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 HILLTOP MALL RD STE 307
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5204
Mailing Address - Country:US
Mailing Address - Phone:510-222-5871
Mailing Address - Fax:
Practice Address - Street 1:2970 HILLTOP MALL RD STE 307
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5204
Practice Address - Country:US
Practice Address - Phone:510-222-5871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2009001900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily