Healthcare Provider Details

I. General information

NPI: 1205190618
Provider Name (Legal Business Name): KRISTEN ELIZABETH DUFFY C.R.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTEN ELIZABETH TOMBLIN

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 Q ST FL 3
SACRAMENTO CA
95816-7058
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 916-733-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95004503
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: