Healthcare Provider Details

I. General information

NPI: 1568269587
Provider Name (Legal Business Name): ALYSSA PLISIC DNP, RN, FNP-C, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CHILDRENS WAY
SAN DIEGO CA
92123-4223
US

IV. Provider business mailing address

1414 OLIVER AVE
SAN DIEGO CA
92109-5378
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-1700
  • Fax:
Mailing address:
  • Phone: 516-817-0083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95018867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: