Jenifer Rezende Sullivan, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

NP95011562 Issued in CA

Practice address

732 Mott Street
100-110
San Fernando, CA 91340-4237

Phone

(818) 963-5690

NPI assigned

Apr 13, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HFDBCA

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.

• Michael Eshaghian MD Inc

  • Obstetrics & Gynecology Physician
  • Tarzana, CA
  • NPI 1235399379
  Medicare reassignment NPD
• Optimal Body Nursing Center, Inc.

  • Family Medicine Physician
  • Santa Clarita, CA
  • NPI 1790563260
  NPD Authorized official
• San Fernando Community Hospital

  • Primary Care Clinic/Center
  • San Fernando, CA
  • NPI 1245669555
  Medicare reassignment
• Miracle Women'S Medical Group Inc

  • Obstetrics & Gynecology Physician
  • Van Nuys, CA
  • NPI 1720217698
  NPD (past)
• San Fernando Community Health Center

  • Clinic/Center
  • San Fernando, CA
  • NPI 1093151821
  NPD (past)

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

{
    "created_epoch": "1555113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696896000000",
    "number": "1326501503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 MOTT STREET",
            "address_2": "100-110",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913404237",
            "telephone_number": "818-963-5690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 MOTT STREET",
            "address_2": "100-110",
            "city": "SAN FERNANDO",
            "state": "CA",
            "postal_code": "913404237",
            "telephone_number": "818-963-5690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "23861 McBean Pkwy Ste A4",
            "address_purpose": "LOCATION",
            "city": "Santa Clarita",
            "state": "CA",
            "postal_code": "913552003",
            "country_code": "US",
            "telephone_number": "661-200-9727",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "JENIFER",
        "middle_name": "REZENDE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-13",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95011562",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95011562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "95011562",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lbarreda@sfchealthcenter.org",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "732 Mott Street",
            "address_2": "100-110",
            "city": "San Fernando",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913404237",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cheryl Rena Spence, RNFA CNP
• Kimberly Spitz Mares, PSYD
• Kathryn Roene Steffen, F.N.P.
• Jennifer Dawn Stevenson, LMFT
• Juventino Suarez
• Sunset Medical Services Inc
• Svetlana Hamer a Prof Dental Corp
• Latisha Swygert, M.S.
• Brett Syring, PT
• Raha Tabankia, L.C.S.W

• Family Nurse Practitioner in San Fernando, CA
• Providers in San Fernando, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; 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.

Verify at the official NPI Registry.