Provider Demographics
NPI:1962485839
Name:REGUERA, TIFFANY LOCKHART (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LOCKHART
Last Name:REGUERA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:LOCKHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2760 N. BALLS FERRY RD.
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3537
Mailing Address - Country:US
Mailing Address - Phone:530-365-4412
Mailing Address - Fax:530-365-5186
Practice Address - Street 1:3082 MCMURRAY DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3544
Practice Address - Country:US
Practice Address - Phone:530-365-4420
Practice Address - Fax:530-365-5186
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA554914363LF0000X
CA13779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ41815Medicare UPIN