Provider Demographics
NPI:1245716943
Name:ESCOBAR, TONYA SHANTEL (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:TONYA
Middle Name:SHANTEL
Last Name:ESCOBAR
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2960 CAMINO DIABLO
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597
Mailing Address - Country:US
Mailing Address - Phone:800-892-2695
Mailing Address - Fax:415-458-2691
Practice Address - Street 1:15861 HIGHWAY 101 S
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-8515
Practice Address - Country:US
Practice Address - Phone:541-254-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202001856NP-PP363LP0808X
MECNP201124363LP0808X
WAAP61152390363LP0808X
NV840336363LP0808X
ID65396363LP0808X
AZ232005363LP0808X
CA95014604363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty