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General NPI Number Information
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NPI Number | 1972313567
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Entity Type | Individual
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Provider Name | GINA MERLENE TYRA FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/07/2025
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 20880 BAKER RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5729
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Country | US
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Telephone | 510-581-5646
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Fax |
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Provider Business Mailing Address
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Address Line | 1442 6TH ST # B
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City | BERKELEY
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State | CA
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Zip | 94710-1431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number | 95032269
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License Number State | CA
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