Provider Demographics
NPI:1669401824
Name:TAPIA, JEANNE ABAYA (DNP, FNP)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:ABAYA
Last Name:TAPIA
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:DR
Other - First Name:JEANNE
Other - Middle Name:FERMINA NICOLAS
Other - Last Name:ABAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP
Mailing Address - Street 1:PO BOX 661360
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91066-1360
Mailing Address - Country:US
Mailing Address - Phone:626-447-0296
Mailing Address - Fax:626-447-6057
Practice Address - Street 1:1050 LINDEN AVE
Practice Address - Street 2:EMPLOYEE HEALTH CLINIC
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:562-491-9095
Practice Address - Fax:562-491-9896
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13932363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN611739Medicaid
CARN611739Medicaid
CAWNP13932AMedicare PIN
CAWNP13932BMedicare PIN