Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MS. ANISHA NICOLE JACKSON, PA
DeactivatedMS. ANISHA NICOLE JACKSON, PA is a Physician Assistant healthcare provider located in SANTA ANA, California. NPI 1174760961 is deactivated in the NPPES registry. Verify at CMS.
Physician Assistant · SANTA ANA, CA
This NPI has been deactivated.
The record was deactivated on August 14, 2019.
Deactivated NPIs are no longer valid for billing or credentialing. The provider may have retired, changed practice status, or had their NPI administratively deactivated.
Verify current licensure status with the NPPES NPI Registry or the relevant state medical board before relying on this record.
Registration Details
- NPI Number
- 1174760961
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jan 15, 2009 (10.578082191781 yrs)
- Last Updated
- Oct 4, 2025
- Deactivated
- Aug 14, 2019
- Licenses
-
56906 (CA)56906 (CA)
Practice Information
- Address
-
5 HUTTON CENTRE DR STE 950SANTA ANA, CA, 927078744Browse CA providers · Browse ZIP 92707
- Phone
- 8554347763
- Primary Specialty
-
Physician Assistant
363A00000X
- Additional Specialty
- 405300000X
Other Physician Assistant Providers in SANTA ANA, CA
| Name | Credential | NPI |
|---|---|---|
| BONNIE SCHULTZ HUCKABY | MPAS, PA-C | 1932109204 |
| MR. RAY GRIJALVA | PA | 1265414130 |
| RANDI IRENE PASSERO | PA C | 1417933409 |
| PAULINE KNIGHT SAEDLER | PA-C | 1649259912 |
| MS. KRISTA MICHELLE KOUSENS | MSPA-C | 1598745622 |
| LETICIA NEDILSKYJ | P.A-C | 1962461392 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.