Provider Demographics
NPI:1245043546
Name:MAGNUS, TOSCA TALIA (FNP)
Entity type:Individual
Prefix:
First Name:TOSCA
Middle Name:TALIA
Last Name:MAGNUS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3654 OLD BLACKHAWK RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4672
Mailing Address - Country:US
Mailing Address - Phone:925-727-2133
Mailing Address - Fax:
Practice Address - Street 1:2920 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2031
Practice Address - Country:US
Practice Address - Phone:415-404-3168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95032310363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner