Provider Demographics
NPI:1902140007
Name:SPEAKS, JASON THOMAS (MS, FNP-C, NP-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:SPEAKS
Suffix:
Gender:M
Credentials:MS, FNP-C, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BEHR AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1182
Mailing Address - Country:US
Mailing Address - Phone:415-696-1696
Mailing Address - Fax:
Practice Address - Street 1:90 BEHR AVE APT 303
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-1182
Practice Address - Country:US
Practice Address - Phone:303-913-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA824970163W00000X
CA22258251E00000X, 363L00000X, 363LC1500X, 363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No251E00000XAgenciesHome Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily