Provider Demographics
NPI:1750048260
Name:HUEZO, TATIANA ELOISA (FNP-C)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:ELOISA
Last Name:HUEZO
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 1:3 HARBOR DR STE 111
Mailing Address - Street 2:
Mailing Address - City:SAUSALITO
Mailing Address - State:CA
Mailing Address - Zip Code:94965
Mailing Address - Country:US
Mailing Address - Phone:415-683-2988
Mailing Address - Fax:415-683-2980
Practice Address - Street 1:3 HARBOR DR STE 111
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965
Practice Address - Country:US
Practice Address - Phone:415-683-2988
Practice Address - Fax:415-683-2980
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily