Active NPI
Jennifer Ann Peterson
- Acute Care Nurse Practitioner
- San Diego, CA
National Provider Identifier
1124822697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 95030994
- Practice address
- 3075 Health Center Dr Ste 400
San Diego, CA 92123-2773 - Phone
- (858) 939-3831
- NPI assigned
- Apr 3, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 95030994 | CA | Primary |
Addresses
Primary practice location
3075 Health Center Dr Ste 400
San Diego, CA 92123-2773
Mailing address
3075 Health Center Dr Ste 400
San Diego, CA 92123-2773
Phone (858) 939-3831
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251105002670 | CA | Order and Referring Only - Nurse Practitioner | 3779073051 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95030994 | CA | MD | Acute Care Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1776816000000",
"number": "1124822697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3075 HEALTH CENTER DR STE 400",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921232773",
"telephone_number": "858-939-3831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3075 HEALTH CENTER DR STE 400",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921232773",
"telephone_number": "858-939-3831"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JENNIFER",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-03",
"last_updated": "2026-04-22",
"certification_date": "2026-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "CA",
"license": "95030994",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.