Provider Demographics
NPI:1366991846
Name:VAN TASSELL, SHARLYNN (FNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:SHARLYNN
Middle Name:
Last Name:VAN TASSELL
Suffix:
Gender:F
Credentials:FNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 N MOOSE CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3643
Mailing Address - Country:US
Mailing Address - Phone:208-308-5650
Mailing Address - Fax:208-308-5650
Practice Address - Street 1:7515 FALCON CREST DR # 200
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-5014
Practice Address - Country:US
Practice Address - Phone:541-904-5216
Practice Address - Fax:541-527-4347
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-26
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID26662363LF0000X
OR20170195BNP-PP363LF0000X
OR201701958NP-PP364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily