Provider Demographics
NPI:1548774623
Name:PONZO, JENNIFER CHRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CHRISTINA
Last Name:PONZO
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 1:207 LEMOORE DR
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4334
Mailing Address - Country:US
Mailing Address - Phone:650-454-9365
Mailing Address - Fax:
Practice Address - Street 1:500 PARNASSUS AVE # MUW-405
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2203
Practice Address - Country:US
Practice Address - Phone:415-353-1606
Practice Address - Fax:415-353-1312
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95007603363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care