Healthcare Provider Details

I. General information

NPI: 1063256204
Provider Name (Legal Business Name): BIANCA VLAD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E ORANGEBURG AVE
MODESTO CA
95350-5510
US

IV. Provider business mailing address

5397 PORT ALICE WAY
SALIDA CA
95368-9637
US

V. Phone/Fax

Practice location:
  • Phone: 312-635-0973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95032822
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11033100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: