Provider Demographics
NPI:1164088506
Name:WINST0N, TANYA RENEE
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:RENEE
Last Name:WINST0N
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:RENEE
Other - Last Name:PUCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 N NORMA ST
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-2575
Mailing Address - Country:US
Mailing Address - Phone:760-463-5062
Mailing Address - Fax:760-499-9259
Practice Address - Street 1:1400 N NORMA ST
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-2575
Practice Address - Country:US
Practice Address - Phone:760-463-5062
Practice Address - Fax:760-499-9259
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator