Provider Demographics
NPI:1972368553
Name:ENSSLIN, STARLA JOY (MSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:STARLA
Middle Name:JOY
Last Name:ENSSLIN
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13465 CHRISTENSEN RD
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8811
Mailing Address - Country:US
Mailing Address - Phone:209-981-9238
Mailing Address - Fax:
Practice Address - Street 1:9299 LAGUNA SPRINGS DR STE 110
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7842
Practice Address - Country:US
Practice Address - Phone:916-259-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily