Provider Demographics
NPI:1457758831
Name:TRIPP, COURTNEY (FNP-C)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:TRIPP
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 PATTERSON RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIVERBANK
Mailing Address - State:CA
Mailing Address - Zip Code:95367-3407
Mailing Address - Country:US
Mailing Address - Phone:209-869-7402
Mailing Address - Fax:
Practice Address - Street 1:2603 PATTERSON RD
Practice Address - Street 2:SUITE 2
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-3407
Practice Address - Country:US
Practice Address - Phone:209-869-7402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily