Provider Demographics
NPI:1164924023
Name:RENNER, TOMASA YVONNE
Entity Type:Individual
Prefix:
First Name:TOMASA
Middle Name:YVONNE
Last Name:RENNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TOMMIE
Other - Middle Name:
Other - Last Name:ESCALERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9625 STAFFORDSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-5601
Mailing Address - Country:US
Mailing Address - Phone:661-889-3009
Mailing Address - Fax:
Practice Address - Street 1:9625 STAFFORDSHIRE WAY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-5601
Practice Address - Country:US
Practice Address - Phone:661-889-3009
Practice Address - Fax:661-889-3009
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA690660164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse