Provider Demographics
NPI:1609431196
Name:STEVENSON-GAINES, TANYA DENISE (DNP)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:DENISE
Last Name:STEVENSON-GAINES
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
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Mailing Address - Street 1:13988 ROYAL MELBOURNE SQ
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-3646
Mailing Address - Country:US
Mailing Address - Phone:858-444-7007
Mailing Address - Fax:619-556-8627
Practice Address - Street 1:34800 BOB WILSON DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-1098
Practice Address - Country:US
Practice Address - Phone:858-444-7007
Practice Address - Fax:619-556-8627
Is Sole Proprietor?:No
Enumeration Date:2019-05-09
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANP95010556363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health