Healthcare Provider Details

I. General information

NPI: 1164148532
Provider Name (Legal Business Name): TARYN HUESTIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

250 FLORIN RD
SACRAMENTO CA
95831-1405
US

IV. Provider business mailing address

2145 SAN ANTONIO AVE
ALAMEDA CA
94501-4326
US

V. Phone/Fax

Practice location:
  • Phone: 916-399-0650
  • Fax:
Mailing address:
  • Phone: 925-324-7714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number729091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: