Provider Demographics
NPI:1770314809
Name:TINGSTAD, TAYLA DIANE (DNP, CNM, WHNP-BC)
Entity type:Individual
Prefix:DR
First Name:TAYLA
Middle Name:DIANE
Last Name:TINGSTAD
Suffix:
Gender:F
Credentials:DNP, CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19691 WATERBURY LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-3542
Mailing Address - Country:US
Mailing Address - Phone:714-925-0007
Mailing Address - Fax:
Practice Address - Street 1:19691 WATERBURY LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-3542
Practice Address - Country:US
Practice Address - Phone:714-925-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95029535363LW0102X
CA236443367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health