Jacquelyn Victoria Zommick, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95020736 Issued in CA

Practice address

28212 Kelly Johnson Pkwy Ste 215
Valencia, CA 91355-5090

Phone

(818) 688-6826

Fax

(877) 349-4481

NPI assigned

Sep 8, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Mental Wellness for Life a Nursing CorporationGroup PAC ID 7214307727, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mental Wellness for Life a Nursing Corporation

  • Psychiatric/Mental Health Nurse Practitioner
  • Valencia, CA
  • NPI 1982326740
  Medicare reassignment Care Compare group NPD Authorized official
• Brainstim Centers, Inc

  • Neurology Physician
  • Valencia, CA
  • NPI 1518506229
  NPD
• Neuro Wellness Spa, a Medical PC

  dba Neuro Wellness Spa

  • Psychiatry Physician
  • Manhattan Beach, CA
  • NPI 1003394149
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1631059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1073282786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28212 KELLY JOHNSON PKWY STE 215",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555090",
            "telephone_number": "818-688-6826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28212 KELLY JOHNSON PKWY STE 215",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913555090",
            "telephone_number": "818-688-6826",
            "fax_number": "877-349-4481"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23500 Park Sorrento Unit A4",
            "address_purpose": "LOCATION",
            "city": "Calabasas",
            "state": "CA",
            "postal_code": "913024117",
            "country_code": "US",
            "telephone_number": "818-688-6862",
            "fax_number": "877-349-4481",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZOMMICK",
        "first_name": "JACQUELYN",
        "middle_name": "VICTORIA",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-08",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95020736",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maliha Zerin
• Laura Zhao
• Benjamin Zheng
• Jason Scott Ziemba, M.D.
• Eileen Clare Zierhut, D.D.S.
• Jenna Lauren Zommick, FNP, RN
• Mona Zuhdi
• Sara Isabel Zuniga
• Anna Zvansky, DO
• Maran Isabelle Zyhailo, RD

• Psychiatric/Mental Health Nurse Practitioner in Valencia, CA
• Providers in Valencia, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.