Active NPI
Tracy Eidson, N.P.
- Nurse Practitioner
- Vallejo, CA
National Provider Identifier
1184995342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 17990
- Practice address
- 210 Hospital Dr
Vallejo, CA 94589-2517 - Phone
- (707) 645-7316
- Fax
- (707) 645-0426
- NPI assigned
- Jan 19, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 17990 | CA | Primary |
Addresses
Primary practice location
210 Hospital Dr
Vallejo, CA 94589-2517
Mailing address
PO Box 22210
Oakland, CA 94623-2210
Phone (510) 535-4000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347321600000",
"number": "1184995342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 22210",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946232210",
"telephone_number": "510-535-4000",
"fax_number": "510-535-4128"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "210 HOSPITAL DR",
"city": "VALLEJO",
"state": "CA",
"postal_code": "945892517",
"telephone_number": "707-645-7316",
"fax_number": "707-645-0426"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EIDSON",
"first_name": "TRACY",
"credential": "N.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-19",
"last_updated": "2012-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "17990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vallejo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.