Healthcare Provider Details

I. General information

NPI: 1376857581
Provider Name (Legal Business Name): TANYA BROWN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451. EAST 12TH ST. 2ND FLOOR
OAKLAND CA
94601-3425
US

IV. Provider business mailing address

P.O. BOX 22210
OAKLAND CA
94623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-3319
  • Fax: 510-535-1487
Mailing address:
  • Phone: 925-676-0505
  • Fax: 925-887-5298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number731105
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number21017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: