Jacqueline Licauco, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95000859 Issued in CA

Practice address

191 S Buena Vista
Suite 100
Burbank, CA 91505-4554

Phone

(818) 869-7600

Fax

(814) 433-3691

NPI assigned

Oct 23, 2014

Sex

Female

Sole proprietor

Yes

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Facey Medical FoundationGroup PAC ID 3173436276, 324 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Saint Joseph Medical Ctr Hospital, Burbank, CA, CCN 050235

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: jlicauco1129294@oc.providencedirect.org

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.

• Providence Facey Medical Foundation

  dba Facey Medical Group

  • Internal Medicine Physician
  • Valencia, CA
  • NPI 1710031588
  Medicare reassignment Care Compare group NPD
• Providence Facey Medical Foundation

  dba Providence Express Care

  • Multi-Specialty Clinic/Center
  • Irvine, CA
  • NPI 1891348447
  NPD
• Ahmc San Gabriel Valley Medical

  dba AHMC San Gabriel Valley Medical Center

  • Skilled Nursing Facility
  • San Gabriel, CA
  • NPI 1710174818
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health System - Southern California

  dba Providence Saint Joseph Medical Center

  • General Acute Care Hospital
  • Burbank, CA
  • NPI 1336173269
  Care Compare affiliation

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781481600000",
    "number": "1467857284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9602",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913469602",
            "telephone_number": "818-837-5559",
            "fax_number": "818-792-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 S BUENA VISTA",
            "address_2": "SUITE 100",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054554",
            "telephone_number": "818-869-7600",
            "fax_number": "814-433-3691"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "811 N Doan Dr",
            "address_purpose": "LOCATION",
            "city": "Burbank",
            "state": "CA",
            "postal_code": "915061523",
            "country_code": "US",
            "telephone_number": "818-441-9270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LICAUCO",
        "first_name": "JACQUELINE",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-10-23",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95000859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alwin Carl Lewis, MD
• Nicole Lewis
• Roya Lewis, M.D.
• Terry Gail Lewis, LMFT
• Zen Jordan Lewis, PHD, LMHC, LPCC
• Emmanuel Licup, PT, DPT
• Lidia Alzate DC a Chiropractic Corporation
• Wayne Peter Liebman, M.D.
• Sophia Clarissa Liem, O.D.
• Life Bridge Hospice Care, Inc.

• Family Nurse Practitioner in Burbank, CA
• Providers in Burbank, 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 Jun 15, 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.
• 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.