Provider Demographics
NPI:1841424066
Name:CARGILL, LUCIA CAROL (PHD, MSN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:LUCIA
Middle Name:CAROL
Last Name:CARGILL
Suffix:
Gender:F
Credentials:PHD, MSN, FNP-C
Other - Prefix:MS
Other - First Name:LUCIA
Other - Middle Name:CAROL
Other - Last Name:ROLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:SEQUOIA MIND HEALTH
Mailing Address - Street 2:1506 4TH ST.
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-527-1315
Mailing Address - Fax:707-527-1307
Practice Address - Street 1:SEQUOIA MIND HEALTH
Practice Address - Street 2:1506 4TH ST
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-527-1315
Practice Address - Fax:707-527-1307
Is Sole Proprietor?:No
Enumeration Date:2009-05-04
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN197365363LF0000X
CANP18603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily