Healthcare Provider Details

I. General information

NPI: 1467368969
Provider Name (Legal Business Name): JOCELLE HARRISON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 CONESTOGA WAY
SAN JOSE CA
95123-4215
US

IV. Provider business mailing address

1612 DIXIE DR
SAN JOSE CA
95122-2505
US

V. Phone/Fax

Practice location:
  • Phone: 510-921-8892
  • Fax:
Mailing address:
  • Phone: 510-921-8892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number435203014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: