Provider Demographics
NPI:1215255062
Name:RODRIGUEZ-SERVA, JACEY JEAN (FNP)
Entity type:Individual
Prefix:
First Name:JACEY
Middle Name:JEAN
Last Name:RODRIGUEZ-SERVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 GUZZI LN
Mailing Address - Street 2:STE C
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-5289
Mailing Address - Country:US
Mailing Address - Phone:209-532-1919
Mailing Address - Fax:209-533-0782
Practice Address - Street 1:690 GUZZI LN
Practice Address - Street 2:STE C
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5289
Practice Address - Country:US
Practice Address - Phone:209-532-1919
Practice Address - Fax:209-533-0782
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19693363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily