Provider Demographics
NPI:1245570266
Name:JENKINS, MARIDEZ BRINAS (FNP)
Entity Type:Individual
Prefix:
First Name:MARIDEZ
Middle Name:BRINAS
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 SANTA LUCIA DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-7615
Mailing Address - Country:US
Mailing Address - Phone:650-270-5162
Mailing Address - Fax:
Practice Address - Street 1:675 YGNACIO VALLEY RD
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3860
Practice Address - Country:US
Practice Address - Phone:650-692-9751
Practice Address - Fax:650-697-0729
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22738363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily