Provider Demographics
NPI:1417731514
Name:RENI, TAMARA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:RENI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 FROG HILL LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-2283
Mailing Address - Country:US
Mailing Address - Phone:661-313-6973
Mailing Address - Fax:
Practice Address - Street 1:4000 DUBLIN BLVD STE 150
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-3180
Practice Address - Country:US
Practice Address - Phone:925-479-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily