Provider Demographics
NPI:1063421741
Name:COMMANDER, JENNIFER L (NP)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:COMMANDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 PUESTA DEL SOL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3007
Mailing Address - Country:US
Mailing Address - Phone:805-705-4663
Mailing Address - Fax:
Practice Address - Street 1:2925 PUESTA DEL SOL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3007
Practice Address - Country:US
Practice Address - Phone:805-705-4663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN625651163W00000X
CA16351363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN625651OtherMED LICENSE
CANP16351OtherMED LICENSE