Provider Demographics
NPI:1548789894
Name:DAVIS, TANYA (RN, PHN)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 WOODLAND PKWY UNIT 123
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-7011
Mailing Address - Country:US
Mailing Address - Phone:858-405-7236
Mailing Address - Fax:
Practice Address - Street 1:15615 POMERADO RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2405
Practice Address - Country:US
Practice Address - Phone:858-613-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95091320163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical