MEDICARE: ANNE JAMESON HARGRAVE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95038742	CA

General Provider Information

NPI Number	:	1609724996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE JAMESON HARGRAVE FNP

Provider Business Mailing Address
First Line	:	1907 ROBINSON AVE UNIT 102
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3234
Country	:	US
Telephone Number	:	518-275-8167
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 CLAIREMONT DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2706
Country	:	US
Telephone Number	:	858-273-5300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2026
Last Update Date	:	03/20/2026

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