Provider Demographics
NPI:1689717480
Name:FRIEDRICH, JO ANN ELIZABETH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:JO ANN
Middle Name:ELIZABETH
Last Name:FRIEDRICH
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:12155 TRIBUTARY POINT DRIVE
Mailing Address - Street 2:#158
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:209-815-1928
Mailing Address - Fax:
Practice Address - Street 1:12155 TRIBUTARY POINT DRIVE
Practice Address - Street 2:#158
Practice Address - City:GOLD RIVER
Practice Address - State:CA
Practice Address - Zip Code:95670
Practice Address - Country:US
Practice Address - Phone:209-815-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10275363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical