Provider Demographics
NPI:1992243711
Name:SURRATT, DAWN (NP)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:SURRATT
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:976 COLLIER DR
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-3820
Mailing Address - Country:US
Mailing Address - Phone:510-735-5801
Mailing Address - Fax:
Practice Address - Street 1:3850 17TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2031
Practice Address - Country:US
Practice Address - Phone:628-217-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-01
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005079363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95005079OtherCALIFORNIA BOARD OF REGISTERED NURSES-NP FURNISHING
CA1689863516Medicaid