Provider Demographics
NPI:1932712239
Name:TANWANGCO BARKER, KRIZZETTE MENDOZA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRIZZETTE
Middle Name:MENDOZA
Last Name:TANWANGCO BARKER
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 1:11865 AVENEL LN
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6910
Mailing Address - Country:US
Mailing Address - Phone:909-831-4481
Mailing Address - Fax:
Practice Address - Street 1:264 N HIGHLAND SPRINGS AVE STE 1A
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3045
Practice Address - Country:US
Practice Address - Phone:951-769-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95014975363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily