Healthcare Provider Details

I. General information

NPI: 1730804758
Provider Name (Legal Business Name): TANYA D RICE FNP, RN, PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANYA HEFLIN

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 09/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 VISTA WAY
OCEANSIDE CA
92056-3622
US

IV. Provider business mailing address

14704 PRESILLA DR
JAMUL CA
91935-4005
US

V. Phone/Fax

Practice location:
  • Phone: 760-681-5222
  • Fax:
Mailing address:
  • Phone: 619-402-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number95021237
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: