Healthcare Provider Details

I. General information

NPI: 1689081390
Provider Name (Legal Business Name): DONNA TANNAHILL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2014
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81709 DR CARREON BLVD STE C3
INDIO CA
92201-5577
US

IV. Provider business mailing address

81767 DR CARREON BLVD SUITE 201
INDIO CA
92201-5597
US

V. Phone/Fax

Practice location:
  • Phone: 760-391-5151
  • Fax: 760-391-5159
Mailing address:
  • Phone: 760-775-4181
  • Fax: 760-775-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number23654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: