Provider Demographics
NPI:1245051242
Name:SMALLWOOD, TRICIA ANNE (NP)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:ANNE
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:158 CRESTMONT DR LOWR APT
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2312
Mailing Address - Country:US
Mailing Address - Phone:631-880-1814
Mailing Address - Fax:
Practice Address - Street 1:3100 SUMMIT ST FL 2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3412
Practice Address - Country:US
Practice Address - Phone:510-869-4000
Practice Address - Fax:510-869-8475
Is Sole Proprietor?:No
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95032510363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology