Healthcare Provider Details
I. General information
NPI: 1053757922
Provider Name (Legal Business Name): JENNIFER LYN GRAFF FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 05/17/2013
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
4650 HOEN AVE
SANTA ROSA CA
95405-9407
US
IV. Provider business mailing address
601 VAN NESS AVE STE E3619
SAN FRANCISCO CA
94102-3200
US
V. Phone/Fax
- Phone: 707-546-0471
- Fax:
- Phone: 415-531-9047
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | 22762 |
| License Number State | CA |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: