Healthcare Provider Details

I. General information

NPI: 1962485839
Provider Name (Legal Business Name): TIFFANY LOCKHART REGUERA F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY LOCKHART F.N.P.

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3082 MCMURRAY DR
ANDERSON CA
96007-3544
US

IV. Provider business mailing address

2760 N. BALLS FERRY RD.
ANDERSON CA
96007-3537
US

V. Phone/Fax

Practice location:
  • Phone: 530-365-4420
  • Fax: 530-365-5186
Mailing address:
  • Phone: 530-365-4412
  • Fax: 530-365-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number554914
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: