Provider Demographics
NPI:1417524059
Name:TAKU, VIRGINIA TIFUH (NP)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:TIFUH
Last Name:TAKU
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 1:2401 E ORANGEBURG AVE STE 330
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3396
Mailing Address - Country:US
Mailing Address - Phone:813-599-1022
Mailing Address - Fax:
Practice Address - Street 1:2401 E ORANGEBURG AVE STE 330
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3396
Practice Address - Country:US
Practice Address - Phone:813-599-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032965363LF0000X
NV833086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily