Healthcare Provider Details

I. General information

NPI: 1023555992
Provider Name (Legal Business Name): ALLISON WHITEHEAD RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 CAPITOLA RD
SANTA CRUZ CA
95062-2912
US

IV. Provider business mailing address

PO BOX 541
SANTA CRUZ CA
95061-0541
US

V. Phone/Fax

Practice location:
  • Phone: 831-427-3500
  • Fax:
Mailing address:
  • Phone: 831-427-3500
  • Fax: 831-454-4488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95005249
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: