Provider Demographics
NPI:1538901491
Name:BORJAS, JACQUELINE ELISABETH (MSN, AGPCNP-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELISABETH
Last Name:BORJAS
Suffix:
Gender:F
Credentials:MSN, AGPCNP-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ELISABETH
Other - Last Name:MCCOOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10543 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-2412
Mailing Address - Country:US
Mailing Address - Phone:512-988-9062
Mailing Address - Fax:
Practice Address - Street 1:10543 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2412
Practice Address - Country:US
Practice Address - Phone:512-988-9062
Practice Address - Fax:512-988-9062
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-11
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX961340163W00000X
CA95037755363LP2300X
HI95200163W00000X
CA95336966163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse