Healthcare Provider Details

I. General information

NPI: 1922625375
Provider Name (Legal Business Name): TAMMIE LIU TSURUOKA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3190 STATE ST STE 102
MEDFORD OR
97504-8498
US

IV. Provider business mailing address

119 LOS PADRES LN
PLACENTIA CA
92870-6232
US

V. Phone/Fax

Practice location:
  • Phone: 541-862-5580
  • Fax:
Mailing address:
  • Phone: 714-494-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: