Provider Demographics
NPI:1194876284
Name:DAMICO, LINDA ANN (NP)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:DAMICO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:BARTEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1510 4TH ST 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1717
Mailing Address - Country:US
Mailing Address - Phone:510-525-8980
Mailing Address - Fax:510-525-8982
Practice Address - Street 1:3603 CERRITO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-1761
Practice Address - Country:US
Practice Address - Phone:510-233-4854
Practice Address - Fax:510-233-4854
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13525363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA514375OtherREG. NURSE LICENSE
CA13525OtherNP FURNISHING NO.