Healthcare Provider Details

I. General information

NPI: 1104418417
Provider Name (Legal Business Name): JAGDISH SINGH NIJJAR FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 E HARDING WAY
STOCKTON CA
95204-6110
US

IV. Provider business mailing address

582 E HARDING WAY
STOCKTON CA
95204-6110
US

V. Phone/Fax

Practice location:
  • Phone: 844-226-9193
  • Fax:
Mailing address:
  • Phone: 844-226-9193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95014232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: