Provider Demographics
NPI:1699456392
Name:JENNIFER HAYHURST PHYSICIAN ASSISTANT APC
Entity type:Organization
Organization Name:JENNIFER HAYHURST PHYSICIAN ASSISTANT APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYHURST
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:949-836-1262
Mailing Address - Street 1:700 E REDLANDS BLVD STE U342
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-6109
Mailing Address - Country:US
Mailing Address - Phone:909-551-3376
Mailing Address - Fax:
Practice Address - Street 1:1467 FORD ST STE 101
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3911
Practice Address - Country:US
Practice Address - Phone:909-551-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty