Provider Demographics
NPI:1174048979
Name:WOOLLARD, NICOLE JESSICA (DNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:JESSICA
Last Name:WOOLLARD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:JESSICA
Other - Last Name:O'NEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:890 EASTLAKE PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4522
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:890 EASTLAKE PKWY STE 301
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4522
Practice Address - Country:US
Practice Address - Phone:619-421-2949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner