Provider Demographics
NPI:1164940433
Name:IN, SOPHEAR (FNP-C)
Entity Type:Individual
Prefix:
First Name:SOPHEAR
Middle Name:
Last Name:IN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:IN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1350 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4202
Mailing Address - Country:US
Mailing Address - Phone:916-392-5184
Mailing Address - Fax:
Practice Address - Street 1:9493 N FORT WASHINGTON RD STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93730-0637
Practice Address - Country:US
Practice Address - Phone:866-808-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007151363LA2100X, 363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health