Healthcare Provider Details

I. General information

NPI: 1184609208
Provider Name (Legal Business Name): JENNIFER GARCIA TARAZON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 LOGAN ST
SELMA CA
93662-3012
US

IV. Provider business mailing address

5567 W BEECHWOOD AVE
FRESNO CA
93722-2806
US

V. Phone/Fax

Practice location:
  • Phone: 559-896-2624
  • Fax: 559-896-3235
Mailing address:
  • Phone: 559-275-3679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP13408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: