Healthcare Provider Details

I. General information

NPI: 1962773580
Provider Name (Legal Business Name): TARYL LYNN NOTHERN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S ANAHEIM HILLS ROAD SUITE 129
ANAHEIM HILLS CA
92807
US

IV. Provider business mailing address

500 S ANAHEIM HILLS ROAD SUITE 129
ANAHEIM HILLS CA
92807
US

V. Phone/Fax

Practice location:
  • Phone: 714-282-1892
  • Fax: 714-282-9682
Mailing address:
  • Phone: 714-282-1892
  • Fax: 714-282-9682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number361783
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: