MEDICARE: VIRGINIA TIFUH TAKU NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95032965	CA
2	363LF0000X	Family Nurse Practitioner	1052884	TX
3	363LF0000X	Family Nurse Practitioner	833086	NV

General Provider Information

NPI Number	:	1417524059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA TIFUH TAKU NP

Provider Business Mailing Address
First Line	:	2401 E ORANGEBURG AVE STE 330
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-3396
Country	:	US
Telephone Number	:	813-599-1022
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 S LANCASTER RD STE 625
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75216-8821
Country	:	US
Telephone Number	:	813-599-1022
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	04/13/2026

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Directions to “ VIRGINIA TIFUH TAKU NP” Practice Location

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