Provider Demographics
NPI:1104305044
Name:NAGEOTTE, TANYA (NP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:NAGEOTTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 LIVEOAK DR
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-2104
Mailing Address - Country:US
Mailing Address - Phone:562-260-6449
Mailing Address - Fax:
Practice Address - Street 1:4549 LIVEOAK DR
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2104
Practice Address - Country:US
Practice Address - Phone:562-260-6449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008516363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health