Provider Demographics
NPI:1619252152
Name:VAN TASSELL, SARAH ELIZABETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:VAN TASSELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4282
Mailing Address - Country:US
Mailing Address - Phone:909-754-5707
Mailing Address - Fax:
Practice Address - Street 1:25835 BARTON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3897
Practice Address - Country:US
Practice Address - Phone:909-558-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily