Healthcare Provider Details

I. General information

NPI: 1699423335
Provider Name (Legal Business Name): NICK DAVID DEUZ MSN, RN, CPNP-AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

3008 94TH ST
EAST ELMHURST NY
11369-1720
US

V. Phone/Fax

Practice location:
  • Phone: 347-820-8007
  • Fax:
Mailing address:
  • Phone: 347-820-8007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberSP025476
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF383437-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: