Provider Demographics
NPI:1316109614
Name:LEVINE, JENNIFER HOPE (PHYSICIAN ASSISTANT-)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HOPE
Last Name:LEVINE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25100
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5100
Mailing Address - Country:US
Mailing Address - Phone:559-326-1222
Mailing Address - Fax:559-326-1225
Practice Address - Street 1:838 NORDAHL RD STE 300
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-3599
Practice Address - Country:US
Practice Address - Phone:760-747-8935
Practice Address - Fax:760-466-0078
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108817363A00000X
NY010789363AS0400X
CAPA21309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical