MEDICARE: DR. TAYLA DIANE TINGSTAD DNP, CNM, WHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LW0102X	Women's Health Nurse Practitioner	95029535	CA
2	367A00000X	Advanced Practice Midwife	236443	CA

General Provider Information

NPI Number	:	1770314809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLA DIANE TINGSTAD DNP, CNM, WHNP-BC

Provider Business Mailing Address
First Line	:	19691 WATERBURY LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-3542
Country	:	US
Telephone Number	:	714-925-0007
Fax Number	:

Provider Business Practice Location Address
First Line	:	19691 WATERBURY LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-3542
Country	:	US
Telephone Number	:	714-925-0007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2024
Last Update Date	:	08/10/2024

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