Provider Demographics
NPI:1366973794
Name:DEEMER, JODI MARIE (MSN, AGPCNP)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:MARIE
Last Name:DEEMER
Suffix:
Gender:F
Credentials:MSN, AGPCNP
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:MARIE
Other - Last Name:CARLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1800 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6019
Mailing Address - Country:US
Mailing Address - Phone:209-461-5043
Mailing Address - Fax:
Practice Address - Street 1:1 HOAG DR
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4162
Practice Address - Country:US
Practice Address - Phone:949-764-8585
Practice Address - Fax:949-764-1960
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95104424163W00000X
MA2307151163W00000X
CANP95006967363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse