Individual provider Active NPI

Jennifer Susan Tustison, FNP, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Newport Beach, CA
National Provider Identifier
1710646435
Registry record updated Jul 8, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95017876 Issued in CA
Practice address
2549 Eastbluff Dr Ste B-757
Newport Beach, CA 92660-3500
Phone
(949) 409-7079
Fax
(949) 220-2605
NPI assigned
Dec 9, 2021
Last updated
Jul 8, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95017876 CA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95017876 CA Primary

Addresses

Primary practice location

2549 Eastbluff Dr Ste B-757
Newport Beach, CA 92660-3500

Mailing address

2549 Eastbluff Dr Ste B-757
Newport Beach, CA 92660-3500
Phone (949) 409-7079

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250516000678 CA Practitioner - Nurse Practitioner 5294253985 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Harbor Psychiatry & Mental Health, Professional Corporation CurrentSince Mar 19, 2025 Accepting new patients

Locations

4631 Teller Ave
Ste 100
Newport Beach, CA 92660
Phone (949) 335-7500

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1639008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783468800000",
    "number": "1710646435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2549 EASTBLUFF DR STE B-757",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926603500",
            "telephone_number": "949-409-7079",
            "fax_number": "949-220-2605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2549 EASTBLUFF DR STE B-757",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926603500",
            "telephone_number": "949-409-7079",
            "fax_number": "949-220-2605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUSTISON",
        "first_name": "JENNIFER",
        "middle_name": "SUSAN",
        "credential": "FNP, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-09",
        "last_updated": "2026-07-08",
        "certification_date": "2026-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95017876",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95017876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.