Provider Demographics
NPI:1699651059
Name:JAMES, TIANA MISCHELLE (LVN)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:MISCHELLE
Last Name:JAMES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12618 GOLDMINE AVE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CA
Mailing Address - Zip Code:95386-9309
Mailing Address - Country:US
Mailing Address - Phone:209-996-2772
Mailing Address - Fax:
Practice Address - Street 1:1782 B ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3102
Practice Address - Country:US
Practice Address - Phone:341-777-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA700590164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty