Provider Demographics
NPI:1891995569
Name:KAZMAR, JOAN (FNP)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:KAZMAR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2670 MEADOWMONT LN
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1900
Mailing Address - Country:US
Mailing Address - Phone:707-575-0986
Mailing Address - Fax:
Practice Address - Street 1:3320 CHANATE RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1708
Practice Address - Country:US
Practice Address - Phone:707-576-4108
Practice Address - Fax:707-576-4087
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5435363L00000X
CA204949163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse