Provider Demographics
NPI:1639533573
Name:CHALFIN, AGATA ANNA (FNP)
Entity Type:Individual
Prefix:
First Name:AGATA
Middle Name:ANNA
Last Name:CHALFIN
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:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:REDWAY
Mailing Address - State:CA
Mailing Address - Zip Code:95560-0769
Mailing Address - Country:US
Mailing Address - Phone:707-923-2783
Mailing Address - Fax:
Practice Address - Street 1:101 WEST COAST RD.
Practice Address - Street 2:
Practice Address - City:REDWAY
Practice Address - State:CA
Practice Address - Zip Code:95560
Practice Address - Country:US
Practice Address - Phone:707-923-2783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2024-01-22
Deactivation Date:2023-05-16
Deactivation Code:
Reactivation Date:2023-08-25
Provider Licenses
StateLicense IDTaxonomies
CA95009471363LF0000X, 363LP0808X
CA95165939163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health