Provider Demographics
NPI:1134209927
Name:CROMAR, JENNIFER HORCH (CNM, NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HORCH
Last Name:CROMAR
Suffix:
Gender:
Credentials:CNM, NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HORCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:630 DRAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965-1107
Mailing Address - Country:US
Mailing Address - Phone:415-339-8813
Mailing Address - Fax:415-339-8814
Practice Address - Street 1:880 LAS GALLINAS AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3437
Practice Address - Country:US
Practice Address - Phone:415-339-8813
Practice Address - Fax:415-339-8814
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1580367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN540714OtherMEDI-CAL