Active NPI
Johanna Green-Jacob, NURSE PRACTITIONER
- Family Nurse Practitioner
- San Diego, CA
National Provider Identifier
1609863968
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 13014
- Practice address
- 823 Gateway Center Way
San Diego, CA 92102-4541 - Phone
- (619) 515-2300
- Fax
- (619) 906-4564
- NPI assigned
- Oct 3, 2005
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 13014 | CA | Primary |
Addresses
Primary practice location
823 Gateway Center Way
San Diego, CA 92102-4541
Mailing address
823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTAN | Other | CA | WNP13014A |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13014 | CA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393286400000",
"number": "1609863968",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "823 GATEWAY CENTER WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921024541",
"telephone_number": "619-515-2300",
"fax_number": "619-906-4564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "823 GATEWAY CENTER WAY",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921024541",
"telephone_number": "619-515-2300",
"fax_number": "619-906-4564"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN-JACOB",
"first_name": "JOHANNA",
"name_prefix": "Mrs.",
"credential": "NURSE PRACTITIONER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-10-03",
"last_updated": "2014-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "13014",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WNP13014A",
"identifier": "PTAN",
"state": "CA"
}
],
"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 Feb 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.