Healthcare Provider Details

I. General information

NPI: 1033431259
Provider Name (Legal Business Name): TARYN CLISSOLD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARYYN CYLBURN

II. Dates (important events)

Enumeration Date: 02/16/2010
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE 15 ICN
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

3333 CALIFORNIA STREET SUITE 1-10
SAN FRANCISCO CA
94118-1981
US

V. Phone/Fax

Practice location:
  • Phone: 414-476-1000
  • Fax:
Mailing address:
  • Phone: 415-514-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number18748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: