Healthcare Provider Details

I. General information

NPI: 1417509274
Provider Name (Legal Business Name): ERICA DANIELA STOLL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 8TH ST
DUBLIN CA
94568-3305
US

IV. Provider business mailing address

2450 ELLIS TOWN DR
TRACY CA
95377-8477
US

V. Phone/Fax

Practice location:
  • Phone: 925-833-7500
  • Fax:
Mailing address:
  • Phone: 408-219-4718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: