Healthcare Provider Details

I. General information

NPI: 1396281911
Provider Name (Legal Business Name): PETA GAY BEZEK FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2017
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 HARTLE CT
NAPA CA
94559-4078
US

IV. Provider business mailing address

300 HARTLE CT
NAPA CA
94559-4078
US

V. Phone/Fax

Practice location:
  • Phone: 866-268-4489
  • Fax:
Mailing address:
  • Phone: 866-268-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95027564
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10029163
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9441794
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: