Provider Demographics
NPI:1346216363
Name:TINGEY, JUDITH WILSON (PAC FNPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:WILSON
Last Name:TINGEY
Suffix:
Gender:F
Credentials:PAC FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SIERRA COLLEGE DRIVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5763
Mailing Address - Country:US
Mailing Address - Phone:530-477-4480
Mailing Address - Fax:530-477-7755
Practice Address - Street 1:280 SIERRA COLLEGE DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-477-4480
Practice Address - Fax:530-477-7755
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPA146110363A00000X
CANP9633363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P37936Medicare UPIN
OPA146110Medicare ID - Type Unspecified