Active NPI
John Tyler Eichenberger, FNP
- Family Nurse Practitioner
- South Lake Tahoe, CA
National Provider Identifier
1275303075
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 95027787
- Practice address
- 2074 Lake Tahoe Blvd Ste 5
South Lake Tahoe, CA 96150-6408 - Phone
- (925) 822-4292
- NPI assigned
- Jan 3, 2024
- Last updated
- Jan 3, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 95027787 | CA | Primary |
Addresses
Primary practice location
2074 Lake Tahoe Blvd Ste 5
South Lake Tahoe, CA 96150-6408
Mailing address
2074 Lake Tahoe Blvd Ste 5
South Lake Tahoe, CA 96150-6408
Phone (925) 822-4292
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95027787 | CA | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1704240000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1704240000000",
"number": "1275303075",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2074 LAKE TAHOE BLVD STE 5",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506408",
"telephone_number": "925-822-4292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2074 LAKE TAHOE BLVD STE 5",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506408",
"telephone_number": "925-822-4292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EICHENBERGER",
"first_name": "JOHN",
"middle_name": "TYLER",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-01-03",
"last_updated": "2024-01-03",
"certification_date": "2024-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CA",
"license": "95027787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.