Provider Demographics
NPI:1386147999
Name:COUNTS, JEANNIN (PA-C)
Entity type:Individual
Prefix:
First Name:JEANNIN
Middle Name:
Last Name:COUNTS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JEANNIN
Other - Middle Name:
Other - Last Name:NEILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 16297
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2297
Mailing Address - Country:US
Mailing Address - Phone:661-425-0420
Mailing Address - Fax:
Practice Address - Street 1:310 S HALCYON RD STE 106
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3863
Practice Address - Country:US
Practice Address - Phone:805-568-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58129363A00000X
FL9110956363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant