Provider Demographics
NPI:1801063912
Name:DAKIS, GEORGETTE DEMETRA (FNP)
Entity type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:DEMETRA
Last Name:DAKIS
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 1:1820 OGDEN DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5384
Mailing Address - Country:US
Mailing Address - Phone:650-375-1800
Mailing Address - Fax:650-375-8269
Practice Address - Street 1:1820 OGDEN DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-5384
Practice Address - Country:US
Practice Address - Phone:650-375-1800
Practice Address - Fax:650-375-8269
Is Sole Proprietor?:No
Enumeration Date:2008-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14710OtherFURNISHING NO.
CAMD1211096OtherDEA