Paula Ann Park, FNP, MSN, BSN, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95012155 Issued in CA

Practice address

29300 Portola Pkwy Ste B
Lake Forest, CA 92630-8741

Phone

(714) 773-2141

NPI assigned

Oct 15, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Master of Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602720000000",
    "number": "1801494398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12270 HAVEN CIR",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925035982",
            "telephone_number": "714-773-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29300 PORTOLA PKWY STE B",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926308741",
            "telephone_number": "714-773-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "PAULA",
        "middle_name": "ANN",
        "credential": "FNP, MSN, BSN, RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95012155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Park Dental Group Inc
• Chris Park
• Christy Park
• Hye Won Park
• Kwan Woo Park, L.AC.
• William K Park, DDS
• Kimberly Ann Parkan, DPT
• Ellen K Parker, MSCCC
• Kamora Mulan Parker
• Nessa Parkinen, D.C.

• Family Nurse Practitioner in Lake Forest, CA
• Providers in Lake Forest, 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 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.