Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 22258 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | 22258 | CA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 22258 | CA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 22258 | CA |
NPI | 1902140007 |
---|---|
Provider Name | Jason Thomas Speaks |
First Address | San Francisco, CA 94131-1182 |
Second Address | San Francisco, CA 94131-1182 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2012 |
Last Update Date | 11/09/2018 |