Healthcare Provider Details

I. General information

NPI: 1992580898
Provider Name (Legal Business Name): TAMMY EASTERBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 11/09/2025
Certification Date: 11/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 VIA CTR STE 200
VISTA CA
92081-6056
US

IV. Provider business mailing address

1968 VIA CTR STE 200
VISTA CA
92081-6056
US

V. Phone/Fax

Practice location:
  • Phone: 760-979-0398
  • Fax: 866-622-6045
Mailing address:
  • Phone:
  • Fax: 866-622-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95026516
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number329136
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95026516
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95086891
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: