Provider Demographics
NPI:1174146211
Name:VICTORIA, JACLYN (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:VICTORIA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 AUTUMN MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-2107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9291 LAGUNA SPRINGS DR STE A
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7843
Practice Address - Country:US
Practice Address - Phone:916-714-9777
Practice Address - Fax:916-714-9713
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics