Provider Demographics
NPI:1508848714
Name:PORQUEZ, MARY JOCELYN (FNP, CNS, APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JOCELYN
Last Name:PORQUEZ
Suffix:
Gender:F
Credentials:FNP, CNS, APRN-BC
Other - Prefix:MS
Other - First Name:JOCELYN
Other - Middle Name:M
Other - Last Name:PORQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP, CS, APRN-BC
Mailing Address - Street 1:760 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1235
Mailing Address - Country:US
Mailing Address - Phone:415-836-1700
Mailing Address - Fax:415-836-1737
Practice Address - Street 1:760 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1235
Practice Address - Country:US
Practice Address - Phone:415-836-1700
Practice Address - Fax:415-836-1737
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP17206363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health