Provider Demographics
NPI:1467876771
Name:MANCINI, JOYCE M (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:M
Last Name:MANCINI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8860 CENTER DR
Practice Address - Street 2:STE 320
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7001
Practice Address - Country:US
Practice Address - Phone:916-537-5079
Practice Address - Fax:916-966-3189
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000262363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily