Healthcare Provider Details

I. General information

NPI: 1821058611
Provider Name (Legal Business Name): NANCY TAMARISK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3443 VILLA LN SUITE 6
NAPA CA
94558-6417
US

IV. Provider business mailing address

3443 VILLA LN SUITE 6
NAPA CA
94558-6417
US

V. Phone/Fax

Practice location:
  • Phone: 707-252-8407
  • Fax: 707-252-8335
Mailing address:
  • Phone: 707-252-8407
  • Fax: 707-252-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number321568/7394
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: