MEDICARE: TAMARA L RENI FNP-C

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	95026049	CA

General Provider Information

NPI Number	:	1417731514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA L RENI FNP-C

Provider Business Mailing Address
First Line	:	1203 FROG HILL LN
Second Line	:
City	:	PLEASANTON
State	:	CA
Zip	:	94566-2283
Country	:	US
Telephone Number	:	661-313-6973
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 DUBLIN BLVD STE 150
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-3180
Country	:	US
Telephone Number	:	925-479-3773
Fax Number	:

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

Provider Enumeration Date	:	08/21/2023
Last Update Date	:	08/21/2023

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