Jacqueline Licauco, NP
NPI 1467857284ActiveIndividual· Nurse Practitioner, Family· Burbank, CA
Nurse Practitioner, Family (NP) with Providence Facey Medical Foundation, practicing in Burbank, California. Their prescriptions cost Medicare Part D more than their services did: $19,935 for 360 claims, against $4,579 paid for services in 2024. Glaxosmithkline, LLC. reported $125.00 in payments in 2025, mostly food and beverage. Lists Providence Saint Joseph Medical Ctr as a hospital affiliation.
Overview
| NPI | 1467857284 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | NP |
| Sole proprietor | Yes |
| NPI issued | Oct 23, 2014 |
| Last updated in NPPES | Jun 15, 2026 |
| Certified by provider | Jun 15, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Nurse Practitioner, Family Primary | 363LF0000X | 95000859 | CA |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Nurse Practitioner (CA) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 38 |
|---|---|
| Services billed | 86 across 27 procedure codes |
| Paid by Medicare | $4,579 |
Part D prescriptions in 2024
| Prescriptions (claims) | 360 · 680 30-day fills |
|---|---|
| Patients | 154 |
| Total drug cost | $19,935 |
| Generic share | 91% of claims |
Education and affiliations
| Graduation year | 2014 |
|---|---|
| Medicare specialty | Nurse Practitioner |
| Telehealth | Offers telehealth |
Medical group
- Providence Facey Medical FoundationValencia, CA · 385 clinicians
Hospital affiliation
- Providence Saint Joseph Medical CtrBurbank, CA
Industry payments (Open Payments)
- 2025$125.00 · 1 payment from 1 company
Top paying companies in 2025
| Company | Amount | Payments |
|---|---|---|
| Glaxosmithkline, LLC. | $125.00 | 1 |
What the 2025 payments were for
- Food and Beverage$125.00 · 1 payment
Receiving payments does not imply wrongdoing. What Open Payments covers ·original records
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