Provider Demographics
NPI:1205143591
Name:NOSSOKOFF, JENNIFER A (PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:A
Last Name:NOSSOKOFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:STOCKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55 HAWTHORNE ST
Mailing Address - Street 2:SUITE 520
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94105-3906
Mailing Address - Country:US
Mailing Address - Phone:415-371-8600
Mailing Address - Fax:
Practice Address - Street 1:55 HAWTHORNE ST
Practice Address - Street 2:SUITE 520
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94105-3906
Practice Address - Country:US
Practice Address - Phone:415-371-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20952363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851617278OtherNPI