Provider Demographics
NPI:1831558196
Name:SOUZA, JEFFREY (FNP)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:SOUZA
Suffix:
Gender:M
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 661587
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95866-1587
Mailing Address - Country:US
Mailing Address - Phone:916-436-3015
Mailing Address - Fax:916-436-3042
Practice Address - Street 1:2 SCRIPPS DR STE 202
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6207
Practice Address - Country:US
Practice Address - Phone:916-436-3015
Practice Address - Fax:916-436-3042
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN328206163WE0900X, 163WX1500X, 163WH0200X, 163WP2201X, 163WW0000X, 163WC0400X, 163W00000X
CA95007688363LF0000X
CARN320206163WC2100X
CANP95007688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0900XNursing Service ProvidersRegistered NurseEnterostomal TherapyGroup - Single Specialty
No163WX1500XNursing Service ProvidersRegistered NurseOstomy Care
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95007688OtherBRN
CARN328206OtherBRN