Provider Demographics
NPI:1194905489
Name:MACCHIARELLA, TAWNYA LEE (NP)
Entity type:Individual
Prefix:MRS
First Name:TAWNYA
Middle Name:LEE
Last Name:MACCHIARELLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:5310 VALLE VIS
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-4259
Mailing Address - Country:US
Mailing Address - Phone:858-966-8800
Mailing Address - Fax:858-966-6769
Practice Address - Street 1:3860 CALLE FORTUNADA STE 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4802
Practice Address - Country:US
Practice Address - Phone:858-309-6303
Practice Address - Fax:858-309-6301
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA471188363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics