Healthcare Provider Details

I. General information

NPI: 1841463361
Provider Name (Legal Business Name): TRAVIS JOHN FITZPATRICK CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2008
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 GARDEN VIEW CT
ENCINITAS CA
92024-2478
US

IV. Provider business mailing address

4848 BAROQUE TER
OCEANSIDE CA
92057-7932
US

V. Phone/Fax

Practice location:
  • Phone: 760-274-2700
  • Fax:
Mailing address:
  • Phone: 660-287-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2001003767
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: