Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jacqueline Anderson

Individual provider Nurse Practitioner · NPI 1205245255

Jacqueline Anderson is a Nurse Practitioner in Santa Rosa, California. Graduated from Georgetown University School of Medicine in 2014, 12 years ago. Practices with Providence Medical Foundation, a 1,465-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
12
Trained at
Georgetown University School of Medicine
Licensed in
CA
In the registry since
2014
Specialties on file
2

Practice location Address checks out

2057 Northfield Dr
Santa Rosa, CA 95403-2073
Phone: (707) 775-8510
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 95000793 (CA)
Nurse Practitioner Taxonomy 363L00000X · Licence 95000793 (CA)

Record details

NPI number1205245255
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedAugust 4, 2014
Last updated in NPPESOctober 14, 2021
Certification dateOctober 14, 2021
Mailing address2057 Northfield Dr, Santa Rosa, CA 95403-2073

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolGEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
Graduated 2014 (12 years in practice)
Group practice Providence Medical Foundation — 1465 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Santa Rosa