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Mrs. Johanna Green-jacob, NURSEPRACTITIONER
Family Nurse Practitioner in San Diego, California
NPI 1609863968

Johanna Green-jacob is a Family Nurse Practitioner based in San Diego, CA and is specialized in Family. Johanna Green-jacob practices in San Diego, CA and has the professional credentials of NURSEPRACTITIONER. The NPI Number for Johanna Green-jacob is 1609863968 and holds a License No. 13014 (California).

The current practice location address for Johanna Green-jacob is 823 Gateway Center Way, San Diego, CA and can be reached out via phone at 619-515-2300 and via fax at 619-906-4564.

Location: 823 Gateway Center Way, San Diego, CA, 92102-4541
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Provider Profile Details
NPI Number
1609863968
Provider Name
Johanna Green-jacob
Credential
NURSEPRACTITIONER
Provider Entity Type
Individual
Gender
Female
Address
823 Gateway Center Way, San Diego, CA, 92102-4541
Phone Number
619-515-2300
Fax Number
619-906-4564
Provider Enumeration Date
10/03/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
PTAN 01 CA WNP13014A
institution
Provider Business Practice Location Address Details
Address
823 Gateway Center Way
City
State
Zip
92102-4541
Phone Number
619-515-2300
Fax Number
619-906-4564
person
Provider Business Mailing Address Details
Address
823 Gateway Center Way
City
State
Zip
92102-4541
Phone Number
619-515-2300
Fax Number
619-906-4564
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
License No.
13014 (California)
Definition
Definition to come...
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