MEDICARE: JENNIFER LYNN RASCOE MSN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95000361	CA

General Provider Information

NPI Number	:	1710303888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN RASCOE MSN FNP

Provider Business Mailing Address
First Line	:	6214 E PACIFIC COAST HWY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4867
Country	:	US
Telephone Number	:	562-961-3668
Fax Number	:	562-961-3669

Provider Business Practice Location Address
First Line	:	6214 E PACIFIC COAST HWY
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-4867
Country	:	US
Telephone Number	:	562-961-3668
Fax Number	:	562-961-3669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	03/12/2014

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