Healthcare Provider Details

I. General information

NPI: 1134357973
Provider Name (Legal Business Name): JANINE KLAIR TARCULAS ACOBA RN, CNS, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2009
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22003 S VERMONT AVE APT 30
TORRANCE CA
90502-2123
US

IV. Provider business mailing address

22003 S VERMONT AVE APT 30
TORRANCE CA
90502-2123
US

V. Phone/Fax

Practice location:
  • Phone: 951-543-6148
  • Fax:
Mailing address:
  • Phone: 951-543-6148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number651778
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number21173
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number3650
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: