Provider Demographics
NPI:1285905489
Name:TONASUT MILLET, ANDREA VIRINDA (NP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:VIRINDA
Last Name:TONASUT MILLET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ANDREA
Other - Middle Name:TONASUT
Other - Last Name:MILLET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:7483 SEQUOIA LANE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-7731
Mailing Address - Country:US
Mailing Address - Phone:909-649-4660
Mailing Address - Fax:
Practice Address - Street 1:900 N HERITAGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-5543
Practice Address - Country:US
Practice Address - Phone:760-371-9160
Practice Address - Fax:661-729-6864
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13799363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner