Healthcare Provider Details

I. General information

NPI: 1063343762
Provider Name (Legal Business Name): AV HEALTH AND WELLNESS A NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 W AVENUE L STE 109F
LANCASTER CA
93534-7207
US

IV. Provider business mailing address

44324 MAHOGANY ST
LANCASTER CA
93535-6366
US

V. Phone/Fax

Practice location:
  • Phone: 404-447-4007
  • Fax:
Mailing address:
  • Phone: 404-447-4007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JACQUELINE NICOLE PALMER
Title or Position: OWNER/PRESIDENT
Credential: NP
Phone: 404-447-4007