Provider Demographics
NPI:1366475071
Name:CALDWELL, PATRICIA A (FNP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:16911 WILLOW GLEN RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95919
Practice Address - Country:US
Practice Address - Phone:530-675-0466
Practice Address - Fax:530-675-0530
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF4530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00776485OtherRAILROAD MEDICARE
CAMC0982240OtherDEA - BROWNSVILLE
P00776485OtherRAILROAD MEDICARE
CI680ZMedicare PIN
P00776485OtherRAILROAD MEDICARE
CAMC1626691OtherDEA - LOMA RICA