Healthcare Provider Details

I. General information

NPI: 1235855297
Provider Name (Legal Business Name): NIGHTINGALE CENTER FOR ADVANCED PRACTICE NURSING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14991 CAMAGE AVE STE B
SONORA CA
95370-9287
US

IV. Provider business mailing address

10650 GOLF LINKS RD
JAMESTOWN CA
95327-9672
US

V. Phone/Fax

Practice location:
  • Phone: 209-214-9430
  • Fax:
Mailing address:
  • Phone: 209-214-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JESSI LAMANUZZI
Title or Position: PROVIDER
Credential: NP
Phone: 209-214-9430