Provider Demographics
NPI:1790524833
Name:TAPANES, ILIANNA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:ILIANNA
Middle Name:MARIE
Last Name:TAPANES
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 1:947 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207-2046
Mailing Address - Country:US
Mailing Address - Phone:818-439-0599
Mailing Address - Fax:
Practice Address - Street 1:947 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207-2046
Practice Address - Country:US
Practice Address - Phone:818-439-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95020224363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty