Provider Demographics
NPI:1649609090
Name:SWANSBROUGH, JESSICA LINDSAY (PA)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LINDSAY
Last Name:SWANSBROUGH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5888 EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-1705
Mailing Address - Country:US
Mailing Address - Phone:714-377-7469
Mailing Address - Fax:714-846-7683
Practice Address - Street 1:5888 EDINGER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-1705
Practice Address - Country:US
Practice Address - Phone:714-377-7469
Practice Address - Fax:714-846-7683
Is Sole Proprietor?:No
Enumeration Date:2013-11-06
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant