Healthcare Provider Details

I. General information

NPI: 1245806850
Provider Name (Legal Business Name): JESSICA FERNANDEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SHIELDS AVE
DAVIS CA
95616-5200
US

IV. Provider business mailing address

949 33RD ST
SACRAMENTO CA
95816-4410
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-1035
  • Fax: 707-754-5842
Mailing address:
  • Phone: 818-825-0264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014983
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: