Provider Demographics
NPI:1245218379
Name:MITCHELL, TAMI LYNN (RN, NP)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:LYNN
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9215 S CLAREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:FOWLER
Mailing Address - State:CA
Mailing Address - Zip Code:93625-9637
Mailing Address - Country:US
Mailing Address - Phone:559-834-6766
Mailing Address - Fax:
Practice Address - Street 1:110 N VALERIA ST
Practice Address - Street 2:SSUITE 406
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-2166
Practice Address - Country:US
Practice Address - Phone:559-486-8888
Practice Address - Fax:559-426-8887
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7204363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41140OtherREGISTERED NURSE LIC
CA7204OtherNURSE PRACTITIONER LIC