Provider Demographics
NPI:1740763523
Name:FRIZNER, TINA (FNP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:FRIZNER
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 1:5416 HOME CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5004
Mailing Address - Country:US
Mailing Address - Phone:912-272-2671
Mailing Address - Fax:
Practice Address - Street 1:5130 COMMONS DR STE 302
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3922
Practice Address - Country:US
Practice Address - Phone:916-223-9361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95009925363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily