Healthcare Provider Details

I. General information

NPI: 1700740404
Provider Name (Legal Business Name): ALDAR SELIMOVIC MSN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR STE 202
SANTA ROSA CA
95403-1671
US

IV. Provider business mailing address

3883 AIRWAY DR STE 202
SANTA ROSA CA
95403-1671
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95037859
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95037859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: