Provider Demographics
NPI:1316599301
Name:COCKER, TANYA P (LVN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:P
Last Name:COCKER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13313 BEN NEVIS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3331
Mailing Address - Country:US
Mailing Address - Phone:714-381-0140
Mailing Address - Fax:
Practice Address - Street 1:13313 BEN NEVIS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3331
Practice Address - Country:US
Practice Address - Phone:714-381-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA271891164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA