Healthcare Provider Details

I. General information

NPI: 1225735590
Provider Name (Legal Business Name): SHEILA MARTIN-PINKARD FNP, PHN, MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 AUTUMN OAK PL
STOCKTON CA
95209-4229
US

IV. Provider business mailing address

PO BOX 691092
STOCKTON CA
95269-1092
US

V. Phone/Fax

Practice location:
  • Phone: 209-740-6436
  • Fax:
Mailing address:
  • Phone: 209-740-6436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95028898
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95071285
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: