Provider Demographics
NPI:1609537919
Name:FREDEKING, ROBIN TOBY (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:TOBY
Last Name:FREDEKING
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HARRISON ST APT 790
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-3879
Mailing Address - Country:US
Mailing Address - Phone:916-770-7648
Mailing Address - Fax:
Practice Address - Street 1:1739 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2714
Practice Address - Country:US
Practice Address - Phone:209-774-9647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95020344363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner