Provider Demographics
NPI:1255886404
Name:ZUCKERMAN, BRIANNA
Entity type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:BRIANNA
Other - Middle Name:MICHELLE
Other - Last Name:SPARROW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2160 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1212
Mailing Address - Country:US
Mailing Address - Phone:805-710-4794
Mailing Address - Fax:
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-476-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004757363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care