Healthcare Provider Details

I. General information

NPI: 1750292512
Provider Name (Legal Business Name): JENNIFER LEIGHANN NICHOLAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER VARGAS

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 S MAIN AVE
FALLBROOK CA
92028-3338
US

IV. Provider business mailing address

225 E 2ND AVE STE 210
ESCONDIDO CA
92025-4244
US

V. Phone/Fax

Practice location:
  • Phone: 760-291-6700
  • Fax:
Mailing address:
  • Phone: 760-291-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95040803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: