Provider Demographics
NPI:1710858436
Name:THISSEN, TAMARA JANE (BSN, RN-C, CEN, AMB-)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:JANE
Last Name:THISSEN
Suffix:
Gender:F
Credentials:BSN, RN-C, CEN, AMB-
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 BROOKTRAIL CT
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-2763
Mailing Address - Country:US
Mailing Address - Phone:707-778-1111
Mailing Address - Fax:
Practice Address - Street 1:400 N MCDOWELL BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2339
Practice Address - Country:US
Practice Address - Phone:707-778-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA725175163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency