Provider Demographics
NPI:1962773580
Name:NOTHERN, TARYL LYNN (NP)
Entity type:Individual
Prefix:
First Name:TARYL
Middle Name:LYNN
Last Name:NOTHERN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 S ANAHEIM HILLS ROAD
Mailing Address - Street 2:SUITE 129
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-282-1892
Mailing Address - Fax:714-282-9682
Practice Address - Street 1:500 S ANAHEIM HILLS ROAD
Practice Address - Street 2:SUITE 129
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-282-1892
Practice Address - Fax:714-282-9682
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361783163W00000X
CA8007363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse