LA TANYA WALLACE (NPI# 1841453487) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841453487 |
| Entity Type | Individual |
| Full Name | LA TANYA WALLACE |
| Credential | FNP |
| Practice Address |
2608 University Ave San Diego CA 92104-2810 |
| Practice Telephone | 6193987473 |
| Mailing Telephone | 6193987473 |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2020-08-20 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 680663 | CA | Nursing Service Providers |
| Y | 363L00000X | Nurse Practitioner | 22485 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
22485 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BOARD OF REGISTERED NURSING | 22485 | 01 |
| CA | CA BRN | 680663 | 01 |
| Street Address |
2608 UNIVERSITY AVE |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92104-2810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750933610 | Hinderberger Dental Corporation | Dentist | 2050 El Cajon Boulevard, San Diego, CA 92104 | 2019-07-11 |
| 1912487265 | Graham Ashton Harris | Dentist | 2310 Craven Street, Bldg 3230, Fpo, AA 92104 | 2018-08-16 |
| 1700393485 | Christian Jacot | Occupational Therapy Assistant | 3128 Nile Street, San Diego, CA 92104 | 2018-01-04 |
| 1316452931 | Enrico Resurreccion Santos | Dental Hygienist | 2310 Craven St. Bldg. 3230, San Diego, CA 92104 | 2017-12-05 |
| 1164940789 | Robert Brian Damone | Acupuncturist | 3370 29th Street, San Diego, CA 92104 | 2017-09-04 |
| 1780100636 | Nicole Palacios | Counselor | 4170 Texas Street, Apt 1, San Diego, CA 92104 | 2017-08-22 |
| 1063938587 | Indie C Oliver Landrum | Case Manager/Care Coordinator | 2220 Broadway, San Diego, CA 92104 | 2017-08-16 |
| 1669829008 | Krystah Lynn Smith | Doula | 3370 Cherokee Ave, Unit 43, San Diego, CA 92104 | 2016-05-16 |
| 1063871853 | Holly Nicole Hinderberger | Dentist | 2050 El Cajon Blvd, San Diego, CA 92104 | 2016-02-22 |
| 1316336258 | Jorge E Talavera | Military Health Care Provider | 3875 Florida St Apt 2, San Diego, CA 92104 | 2015-01-15 |
| Find all providers in zip 92104 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417560467 | Helen Regina Stearns | Nurse Practitioner | 8797 Encino Ave, San Diego, CA 92123-3952 | 2020-08-28 |
| 1346852480 | Jenna Juenger | Nurse Practitioner | 10665 Calle Mar De Mariposa Apt 3215, San Diego, CA 92130-8730 | 2020-08-19 |
| 1750908414 | Deborah Lynne Monaghan | Nurse Practitioner | 14471 Via Venezia Apt 601, San Diego, CA 92129-1657 | 2020-06-29 |
| 1780211300 | Amanda Renee Phillips | Nurse Practitioner | 3034 Horton Ave, San Diego, CA 92103-6008 | 2020-03-24 |
| 1538792304 | Allison D White | Nurse Practitioner | 726 W Pennsylvania Ave, San Diego, CA 92103-3804 | 2020-02-19 |
| 1356981351 | Jordan Rae Burke | Nurse Practitioner | 11943 El Camino Real Ste 100, San Diego, CA 92130-2597 | 2020-01-08 |
| 1598319436 | Madison Taylor Shreeve | Nurse Practitioner | 3435 Del Mar Heights Rd # D6a, San Diego, CA 92130-2225 | 2019-07-29 |
| 1659930485 | Lovella Medilo | Nurse Practitioner | 4033 3rd Ave Ste 430, San Diego, CA 92103-2117 | 2019-06-05 |
| 1306300272 | Stephanie O'brien Sramek | Nurse Practitioner | 4077 5th Ave # Ems, San Diego, CA 92103-2105 | 2019-01-25 |
| 1467930875 | Reliable Care Md On The Go | Nurse Practitioner | 4565 Ruffner St Ste 201, San Diego, CA 92111-2259 | 2018-07-30 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.