Provider Demographics
NPI:1194248278
Name:BARBACH, TESS (APRN)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:
Last Name:BARBACH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 RITTER ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3323
Mailing Address - Country:US
Mailing Address - Phone:510-520-6166
Mailing Address - Fax:
Practice Address - Street 1:5227 SACRAMENTO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-5427
Practice Address - Country:US
Practice Address - Phone:510-520-6166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0106285163W00000X
CA95007360363LF0000X
VT101.0129218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse