Provider Demographics
NPI:1306911219
Name:BRICENO, JOAN E (FNP)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:E
Last Name:BRICENO
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 1:659 S. CENTRAL VALLEY HWY
Mailing Address - Street 2:P.O. BOX 1060
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2790
Mailing Address - Country:US
Mailing Address - Phone:760-632-0599
Mailing Address - Fax:760-726-4233
Practice Address - Street 1:525 ROBERTS LANE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308
Practice Address - Country:US
Practice Address - Phone:661-392-7850
Practice Address - Fax:661-215-2349
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP16663363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner