Provider Demographics
NPI:1740679794
Name:ROGERS, TALIA (RN, FNP)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 BLUEBELL PL
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-8042
Mailing Address - Country:US
Mailing Address - Phone:510-449-6481
Mailing Address - Fax:
Practice Address - Street 1:130 BLUEBELL PL
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8042
Practice Address - Country:US
Practice Address - Phone:510-449-6481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003547363LF0000X
CA731748163W00000X
CA1328290390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program