Provider Demographics
NPI:1164708640
Name:OCANSEY, PRINCE (FNP)
Entity Type:Individual
Prefix:MR
First Name:PRINCE
Middle Name:
Last Name:OCANSEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 MISSION BLVD STE P
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-2600
Mailing Address - Country:US
Mailing Address - Phone:833-865-8263
Mailing Address - Fax:951-742-8687
Practice Address - Street 1:1050 KENDALL DR STE F
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-4125
Practice Address - Country:US
Practice Address - Phone:909-352-6655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP21235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily