Provider Demographics
NPI:1396854246
Name:JONES, TALYNUA RENESE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TALYNUA
Middle Name:RENESE
Last Name:JONES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TALYNUA
Other - Middle Name:RENESE
Other - Last Name:BENNETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:5385 FRANKLIN BLVD
Practice Address - Street 2:SUITE A-D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-4717
Practice Address - Country:US
Practice Address - Phone:916-452-7305
Practice Address - Fax:916-452-9753
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GK550ZOtherMEDICARE PTAN