Provider Demographics
NPI:1508201443
Name:O'SHEA, TRACEY AMANDA (FNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:AMANDA
Last Name:O'SHEA
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 1:10 MOUNT PLUTO PL
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95835-1418
Mailing Address - Country:US
Mailing Address - Phone:916-600-3045
Mailing Address - Fax:
Practice Address - Street 1:2414 ASHBY AVE STE 201
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2063
Practice Address - Country:US
Practice Address - Phone:510-849-6500
Practice Address - Fax:510-849-6500
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA797669163W00000X
CA23204363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse