Provider Demographics
NPI:1235546888
Name:PENA, TAMISHA (FNP)
Entity Type:Individual
Prefix:
First Name:TAMISHA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:NV
Mailing Address - Zip Code:89316-1513
Mailing Address - Country:US
Mailing Address - Phone:775-237-5642
Mailing Address - Fax:775-237-5652
Practice Address - Street 1:250 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:NV
Practice Address - Zip Code:89316-1513
Practice Address - Country:US
Practice Address - Phone:775-237-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18792363LF0000X
NVAPRN002757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily