Provider Demographics
NPI:1871290098
Name:YOO, TANYA (FNP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9547 SAUTERNE WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4644
Mailing Address - Country:US
Mailing Address - Phone:916-276-0730
Mailing Address - Fax:
Practice Address - Street 1:1909 GALILEO CT
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95618-4890
Practice Address - Country:US
Practice Address - Phone:530-758-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024152163WH1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH1000XNursing Service ProvidersRegistered NurseHospice