Healthcare Provider Details

I. General information

NPI: 1164074977
Provider Name (Legal Business Name): JENNIFER AMY PRATT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER AMY SICKELS

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 04/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24910 LAS BRISAS RD STE 105
MURRIETA CA
92562-4010
US

IV. Provider business mailing address

44641 HOWELL MOUNTAIN ST
TEMECULA CA
92592-1506
US

V. Phone/Fax

Practice location:
  • Phone: 951-231-1385
  • Fax: 866-345-3272
Mailing address:
  • Phone: 619-865-4697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95011967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: