Provider Demographics
NPI:1508190380
Name:AGACITE, SHARON (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:AGACITE
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W GONZALES RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-3075
Mailing Address - Country:US
Mailing Address - Phone:805-983-0691
Mailing Address - Fax:
Practice Address - Street 1:1200 W GONZALES RD STE 300
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3075
Practice Address - Country:US
Practice Address - Phone:805-983-0691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2024-01-21
Deactivation Date:2022-02-15
Deactivation Code:
Reactivation Date:2022-03-01
Provider Licenses
StateLicense IDTaxonomies
CAVN214098164X00000X
CA95020013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164X00000XNursing Service ProvidersLicensed Vocational Nurse