Enneman Irene Tad-Awan, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95029080 Issued in CA

Practice address

1173 Front St
San Diego, CA 92101-3904

Phone

(619) 409-5000

NPI assigned

Mar 3, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1740960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1023816501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "683 ASH AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919105338",
            "telephone_number": "417-860-9671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1173 FRONT ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013904",
            "telephone_number": "619-409-5000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "451 Riverview Pkwy",
            "address_purpose": "LOCATION",
            "city": "Santee",
            "state": "CA",
            "postal_code": "920715829",
            "country_code": "US",
            "telephone_number": "619-258-3200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAD-AWAN",
        "first_name": "ENNEMAN IRENE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-03",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95029080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward Aaron Tackett
• Freddie Tackett
• Ismael D Tactay Jr., RRT
• Stephanie Marie Tactay, MSN, RN, PMH-BC
• Tactical Rehabilitation, Inc.
• Faye K Tada, D.D.S.
• Kim M Taddie, NP
• Michael Adam Taddonio, MD
• Sierra Tade-Moss
• Bekana K Tadese, MPH

• Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.