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Contact Information

MARA IACONI, ANP-C
3841 BRICKWAY BLVD
SANTA ROSA VA
SANTA ROSA, CA95403
 Phone: 415-314-6442
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Adult Health

363LA2200X 50 Nurse Practitioner
 

Registered Nurse

163W00000X
Indicates primary specialty

NPI Profile & details for MARA IACONI · (Female)

NPI # 1528333481
Status Active
Credentials ANP-C
Entity Individual
Enumeration date 03/12/2012
Last updated 04/20/2016 - About 10 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # 21667
  • CA License # 807299
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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