Provider Demographics
NPI:1548346083
Name:NEWCOMBE, JENNIFER BETH (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BETH
Last Name:NEWCOMBE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7688 BELPINE PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6716
Mailing Address - Country:US
Mailing Address - Phone:909-944-8396
Mailing Address - Fax:
Practice Address - Street 1:4440 BROCKTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4068
Practice Address - Country:US
Practice Address - Phone:951-684-8020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15400363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA559583OtherRN LICENSE
CA15400OtherNP FURNISHING