Provider Demographics
NPI:1790885671
Name:MESA, ROBIN BOSWELL (NP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:BOSWELL
Last Name:MESA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4261 PINEHURST CIR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-1885
Mailing Address - Country:US
Mailing Address - Phone:209-478-6372
Mailing Address - Fax:
Practice Address - Street 1:2216 N CALIFORNIA ST
Practice Address - Street 2:STE C
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-5533
Practice Address - Country:US
Practice Address - Phone:209-462-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN431090/NP6168363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner