Provider Demographics
NPI:1699321372
Name:AMOS, TRAVITA MARIE (NP)
Entity type:Individual
Prefix:MS
First Name:TRAVITA
Middle Name:MARIE
Last Name:AMOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1434 RIVA TRIGOSO DR
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-8462
Mailing Address - Country:US
Mailing Address - Phone:209-594-2937
Mailing Address - Fax:
Practice Address - Street 1:1434 RIVA TRIGOSO DR
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-8462
Practice Address - Country:US
Practice Address - Phone:209-594-2937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95024178363L00000X
CA701741163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner