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General NPI Number Information
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NPI Number | 1679294409
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Entity Type | Individual
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Provider Name | JON MARRINAN FNP
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Gender | Male
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Dates
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Enumeration Date | 09/09/2022
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Last Update Date | 09/28/2022
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Provider Practice Location Address
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Address Line | 4150 CLEMENT ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-1563
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Country | US
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Telephone | 707-569-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 538 COLGAN AVE
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City | SANTA ROSA
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State | CA
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Zip | 95404-5908
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Country | US
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Telephone | 707-304-1987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95022070
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License Number State | CA
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