Provider Demographics
NPI:1558195669
Name:ENCINAS GARDNER, TAMMY FAITH
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:FAITH
Last Name:ENCINAS GARDNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 LACEBARK ST
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2145
Mailing Address - Country:US
Mailing Address - Phone:760-522-9082
Mailing Address - Fax:
Practice Address - Street 1:934 LACEBARK ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2145
Practice Address - Country:US
Practice Address - Phone:760-522-9082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-306918163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant