Provider Demographics
NPI:1689307779
Name:RATLEDGE, TAMBRA LAJOY (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMBRA
Middle Name:LAJOY
Last Name:RATLEDGE
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 1:30757 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-7204
Mailing Address - Country:US
Mailing Address - Phone:951-240-7492
Mailing Address - Fax:
Practice Address - Street 1:27699 JEFFERSON AVE STE 210
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2696
Practice Address - Country:US
Practice Address - Phone:951-225-4419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA739351163W00000X
CA95021665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse