Provider Demographics
NPI:1134904782
Name:PISCIOTTA, ANNIKA (NP)
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:
Last Name:PISCIOTTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2554 VINEYARD RD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-3638
Mailing Address - Country:US
Mailing Address - Phone:415-717-4892
Mailing Address - Fax:
Practice Address - Street 1:145 TAMAL RD
Practice Address - Street 2:
Practice Address - City:FOREST KNOLLS
Practice Address - State:CA
Practice Address - Zip Code:94933-0864
Practice Address - Country:US
Practice Address - Phone:818-041-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95033244363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health