Provider Demographics
NPI:1730804758
Name:RICE, TANYA D (FNP, RN, PHN)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:D
Last Name:RICE
Suffix:
Gender:F
Credentials:FNP, RN, PHN
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:HEFLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14704 PRESILLA DR
Mailing Address - Street 2:
Mailing Address - City:JAMUL
Mailing Address - State:CA
Mailing Address - Zip Code:91935-4005
Mailing Address - Country:US
Mailing Address - Phone:619-402-6692
Mailing Address - Fax:
Practice Address - Street 1:3156 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3622
Practice Address - Country:US
Practice Address - Phone:760-681-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95021237363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health