MEDICARE: JUDITH JUNE TARRANT RN, FNP

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	363LP0200X	Pediatric Nurse Practitioner	134507	CA
2	363LP2300X	Primary Care Nurse Practitioner	134507	CA

General Provider Information

NPI Number	:	1619052511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH JUNE TARRANT RN, FNP

Provider Business Mailing Address
First Line	:	2101 STONE BLVD
Second Line	:	SUITE 100
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-4044
Country	:	US
Telephone Number	:	916-371-3787
Fax Number	:	916-371-3790

Provider Business Practice Location Address
First Line	:	2101 STONE BLVD
Second Line	:	SUITE 100
City	:	WEST SACRAMENTO
State	:	CA
Zip	:	95691-4044
Country	:	US
Telephone Number	:	916-371-3787
Fax Number	:	916-371-3790

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

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	06/11/2013

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