Healthcare Provider Details

I. General information

NPI: 1376173476
Provider Name (Legal Business Name): SHARON SUZANNE BRYDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHARON SUZANNE JONES

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 LA CASA VIA STE 200
WALNUT CREEK CA
94598-4866
US

IV. Provider business mailing address

9746 TAREYTON AVE
SAN RAMON CA
94583-3146
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-6644
  • Fax:
Mailing address:
  • Phone: 925-788-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95012882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: