Nicollette Mitra, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95010361 Issued in CA

Practice address

2400 Balfour Rd Ste 302
Brentwood, CA 94513-4955

Phone

(925) 285-2649

NPI assigned

Jun 21, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Nicollette Guillen Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561075200000",
    "number": "1295396125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1871 CAMINO ESTRADA",
            "city": "CONCORD",
            "state": "CA",
            "postal_code": "945212439",
            "telephone_number": "925-285-2649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 BALFOUR RD STE 302",
            "city": "BRENTWOOD",
            "state": "CA",
            "postal_code": "945134955",
            "telephone_number": "925-285-2649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITRA",
        "first_name": "NICOLLETTE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-21",
        "last_updated": "2019-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95010361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLLETTE",
            "last_name": "GUILLEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jaida Marie Minton
• Judy J Miranda, R.N.
• Sinchan Mishra
• Carlos Mitchell
• Nathalie Ramos Mitose
• Cecelia Monique Moctezuma
• Carl Neilon Modeste, PHD
• Rasheed Mohamed
• Mary Mohs
• Nina Mokhtarzada

• Family Nurse Practitioner in Brentwood, CA
• Providers in Brentwood, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.