Healthcare Provider Details

I. General information

NPI: 1659102564
Provider Name (Legal Business Name): CALLIE HOBBS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR STE 320
SANTA ROSA CA
95403-1671
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-7750
  • Fax:
Mailing address:
  • Phone: 707-521-7750
  • Fax: 707-573-5427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030858
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: