Healthcare Provider Details

I. General information

NPI: 1376469817
Provider Name (Legal Business Name): TIFFANY ANN WHITE BEAR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 12TH ST
OAKLAND CA
94607-4927
US

IV. Provider business mailing address

525 12TH ST
OAKLAND CA
94607-4927
US

V. Phone/Fax

Practice location:
  • Phone: 559-741-5933
  • Fax:
Mailing address:
  • Phone: 559-741-5933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95134414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: