Provider Demographics
NPI:1366296600
Name:TAHOE TRUCKEE ADVANCED PSYCHIATRIC NURSING A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TAHOE TRUCKEE ADVANCED PSYCHIATRIC NURSING A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:VARZOS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP-BC
Authorized Official - Phone:203-314-6075
Mailing Address - Street 1:12121 SIERRA DR E
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-5050
Mailing Address - Country:US
Mailing Address - Phone:203-314-6075
Mailing Address - Fax:
Practice Address - Street 1:10368 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0427
Practice Address - Country:US
Practice Address - Phone:775-298-1118
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty