Provider Demographics
NPI:1255937595
Name:FRIGILLANA, JACQUELINE CHARMAINE (FNP-C)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:CHARMAINE
Last Name:FRIGILLANA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 TURTLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-1007
Mailing Address - Country:US
Mailing Address - Phone:661-431-4913
Mailing Address - Fax:
Practice Address - Street 1:806 TURTLE CREST DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-1007
Practice Address - Country:US
Practice Address - Phone:661-431-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANAOtherNA