Healthcare Provider Details

I. General information

NPI: 1942681309
Provider Name (Legal Business Name): JENNIFER ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19500 HOMESTEAD RD
CUPERTINO CA
95014-0600
US

IV. Provider business mailing address

19500 HOMESTEAD RD
CUPERTINO CA
95014-0600
US

V. Phone/Fax

Practice location:
  • Phone: 408-783-4000
  • Fax: 408-217-6140
Mailing address:
  • Phone: 408-783-4000
  • Fax: 408-217-6140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95008239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: