Healthcare Provider Details

I. General information

NPI: 1740818012
Provider Name (Legal Business Name): YOLANDA TIZCARENO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 E ILLINOIS AVE FL 4
FRESNO CA
93701-2125
US

IV. Provider business mailing address

298 W PORTLAND AVE
FRESNO CA
93711-6042
US

V. Phone/Fax

Practice location:
  • Phone: 559-486-8888
  • Fax:
Mailing address:
  • Phone: 559-598-9982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95014002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: