Healthcare Provider Details

I. General information

NPI: 1538689310
Provider Name (Legal Business Name): JENNIFER MICHELLE QUAIL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER MICHELLE COYLE NP

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

838 NORDAHL RD FL 3
SAN MARCOS CA
92069-3595
US

IV. Provider business mailing address

PO BOX 25100
FRESNO CA
93729-5100
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-8935
  • Fax: 760-466-0078
Mailing address:
  • Phone: 760-747-8935
  • Fax: 760-466-0078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: