Basic Information
Provider Information
NPI: 1033556501
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRICE
FirstName: HITTA
MiddleName: JENNIFER
NamePrefix:  
NameSuffix:  
Credential: FNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5379 BALBOA AVE
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921176913
CountryCode: US
TelephoneNumber: 8584058926
FaxNumber:  
Practice Location
Address1: 5379 BALBOA AVE
Address2:  
City: SAN DIEGO
State: CA
PostalCode: 921176913
CountryCode: US
TelephoneNumber: 8584058926
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/23/2013
LastUpdateDate: 05/23/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X22559CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

ID Information
IDTypeStateIssuerDescription
2255901CANURSE PRACTITIONEROTHER


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