| Organization Name: | JENNIFER PACK, NURSE PRACTITIONER, APC |
| NPI Number: | 1043533870 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JENNIFER LYNN PACK (PRESIDENT) |
| Mailing Address: | 15706 Pomerado Rd Suite S 206 Poway |
| State: | CA US |
| Postal Code: | 920642067 |
| Phone Number: | 8584858022 |
| Fax Number: | 8588156820 |
| NPI Enumeration Date: | 03/08/2010 |
| NPI Last Update Date: | 03/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 11906 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |