Healthcare Provider Details

I. General information

NPI: 1891968459
Provider Name (Legal Business Name): TAMMY JO WHITE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 03/31/2022
Certification Date: 03/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 BRESLAUER WAY
REDDING CA
96001-4246
US

IV. Provider business mailing address

21730 HIDY WAY
RED BLUFF CA
96080-7987
US

V. Phone/Fax

Practice location:
  • Phone: 530-245-6753
  • Fax:
Mailing address:
  • Phone: 530-310-4740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: