Provider Demographics
NPI:1992923668
Name:NGUYEN, JENNIFER T (PA-C, MPH)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:T
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 BANCROFT DR
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-6935
Mailing Address - Country:US
Mailing Address - Phone:916-933-5284
Mailing Address - Fax:
Practice Address - Street 1:50 E HAMILTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0251
Practice Address - Country:US
Practice Address - Phone:408-374-0401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19150363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant