Healthcare Provider Details

I. General information

NPI: 1174725956
Provider Name (Legal Business Name): NICOLE TOWNSEND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 PEACH ST STE A
SAN LUIS OBISPO CA
93401-2871
US

IV. Provider business mailing address

1250 PEACH ST STE A
SAN LUIS OBISPO CA
93401-2871
US

V. Phone/Fax

Practice location:
  • Phone: 805-543-4043
  • Fax: 805-543-7640
Mailing address:
  • Phone: 805-543-4043
  • Fax: 805-543-7640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA19178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: