Provider Demographics
NPI:1619653961
Name:JAFFE, ALYSSA POWELL (NP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:POWELL
Last Name:JAFFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:POWELL
Other - Last Name:JAFFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ALYSSA ANN POWELL
Mailing Address - Street 1:45 CREEK VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1489
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:45 CREEK VIEW CIR
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1489
Practice Address - Country:US
Practice Address - Phone:925-286-4694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-22
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005758363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner