Provider Demographics
NPI:1275206062
Name:GOLDSTEIN, TINA GELLER (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:GELLER
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DANIEL BURNHAM CT STE 330C
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-5482
Mailing Address - Country:US
Mailing Address - Phone:415-668-0888
Mailing Address - Fax:
Practice Address - Street 1:1 DANIEL BURNHAM CT STE 330C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-5482
Practice Address - Country:US
Practice Address - Phone:415-668-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily