Jacqueline Licauco, NP | |
191 S Buena Vista, Suite 100, Burbank, CA 91505-4554 | |
(818) 869-7600 | |
(814) 433-3691 |
Full Name | Jacqueline Licauco |
---|---|
Gender | Female |
Speciality | Nurse Practitioner |
Experience | 10 Years |
Location | 191 S Buena Vista, Burbank, California |
Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1467857284 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 95000859 (California) | Primary |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Providence Facey Medical Foundation | 3173436276 | 274 |
Entity Name | Providence Facey Medical Foundation |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1710031588 PECOS PAC ID: 3173436276 Enrollment ID: O20031105000822 |
Mailing Address | Practice Location Address |
---|---|
Jacqueline Licauco, NP Po Box 9602, Mission Hills, CA 91346-9602 Ph: (818) 837-5559 | Jacqueline Licauco, NP 191 S Buena Vista, Suite 100, Burbank, CA 91505-4554 Ph: (818) 869-7600 |
Caitlin Provost Conlon, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 191 S Buena Vista St, Burbank, CA 91505 Phone: 818-557-2671 | |
Anasheh Avanes, FNP-C Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1130 W Olive Ave, Burbank, CA 91506 Phone: 747-477-1411 | |
Jennifer S Lee, AGNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 201 S Buena Vista St Ste 325, Burbank, CA 91505 Phone: 818-842-7145 | |
Lynn Adora Lima, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: Minute Clinic 9795 Burbank, 511 N Hollywood Way, Burbank, CA 91505 Phone: 818-841-0710 | |
Jessica Cuesta, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 241 W Olive Ave, Burbank, CA 91502 Phone: 818-848-5561 | |
Jesselyn Joy Walter, NP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1211 W Magnolia Blvd, Burbank, CA 91506 Phone: 323-620-3463 | |
Mrs. Forreline Grigsby Wilson, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 511 N Hollywood Way, Burbank, CA 91505 Phone: 866-389-2727 |