Tanner Pavelka, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95036682 Issued in CA

Practice address

2425 Blom St
San Diego, CA 92109-3735

Phone

(704) 689-5482

NPI assigned

Nov 25, 2025

Sex

Male

Sole proprietor

Yes

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": "1764028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764028800000",
    "number": "1659233955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 BLOM ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921093735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 BLOM ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921093735",
            "telephone_number": "704-689-5482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVELKA",
        "first_name": "TANNER",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-11-25",
        "last_updated": "2025-11-25",
        "certification_date": "2025-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95036682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desiree Marie-Belle Paus, L.AC, HHP, MS, AS
• Lucy Frances Jeansonne Pauseback, L.AC., C.M.T.
• Sarah Marie Pauter
• Frank L Pavel, D.M.D.
• Alissa Leigh Pavelka, RADT
• Dianne Christine Sison Pavia, RN
• Sophia Pavia
• Austin Pavin
• Anthony Pavlacka, BCBA
• Amanda Marie Pavlak

• Psychiatric/Mental Health Nurse Practitioner in San Diego, CA
• Providers in San Diego, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 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.