Provider Demographics
NPI:1629240049
Name:ALICAR, AGNES TAGORDA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:TAGORDA
Last Name:ALICAR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1801 E MARCH LN
Mailing Address - Street 2:STE C-320
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6629
Mailing Address - Country:US
Mailing Address - Phone:209-957-5888
Mailing Address - Fax:209-477-9337
Practice Address - Street 1:1801 E MARCH LN
Practice Address - Street 2:STE C-320
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6629
Practice Address - Country:US
Practice Address - Phone:209-957-5888
Practice Address - Fax:209-477-9339
Is Sole Proprietor?:No
Enumeration Date:2008-03-26
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CARN585873163W00000X
CAPHN69084163WC1500X
CANP17392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health