Healthcare Provider Details

I. General information

NPI: 1255886404
Provider Name (Legal Business Name): MRS. BRIANNA ZUCKERMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS BRIANNA MICHELLE SPARROW

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

2160 LAKE ST
SAN FRANCISCO CA
94121-1212
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1000
  • Fax:
Mailing address:
  • Phone: 805-710-4794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95004757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: