=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801038245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TARA LYNN VALCARCEL RN, CPNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2009
-----------------------------------------------------
Last Update Date | 01/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 533 PARNASSUS AVE # U-127 BOX 0107
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94143-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-502-4258
-----------------------------------------------------
Fax | 415-502-7540
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 533 PARNASSUS AVE # U-127 BOX 0107
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94143-2208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-502-4258
-----------------------------------------------------
Fax | 415-502-7540
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 19784
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 706683
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------