Provider Demographics
NPI:1710179783
Name:TANNENBAUM, CHERYL ZAPPAS (NP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ZAPPAS
Last Name:TANNENBAUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CHERIE
Other - Middle Name:ZAPPAS
Other - Last Name:TANNENBAUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:9 EYE ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1755
Mailing Address - Country:US
Mailing Address - Phone:415-828-1700
Mailing Address - Fax:
Practice Address - Street 1:5 BON AIR RD STE 105
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1137
Practice Address - Country:US
Practice Address - Phone:415-461-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA257187163W00000X
CA609 FURNISHING NUMBE363LA2200X
CA609363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse