Individual provider Active NPI

Tamara Jane Thissen, BSN, RN-C, CEN, AMB-

  • Emergency Registered Nurse
  • Petaluma, CA
National Provider Identifier
1710858436
Registry record updated Sep 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Registered NurseTaxonomy code 163WE0003X
License
725175 Issued in CA
Practice address
400 N McDowell Blvd
Petaluma, CA 94954-2339
Phone
(707) 778-1111
NPI assigned
Sep 16, 2025
Last updated
Sep 16, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Registered Nurse 163WE0003X 725175 CA Primary

Addresses

Primary practice location

400 N McDowell Blvd
Petaluma, CA 94954-2339

Mailing address

122 Brooktrail CT
Santa Rosa, CA 95409-2763
Phone (707) 778-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2026
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1873 W Traverse Pkwy
Suite E 100
Lehi, UT 84048-5985

9327 S 3400
West Jordan, UT 84088-8821

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing

State licenses

LicenseStateTypeSpecialty
725175CAMDEmergency Registered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1757980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757980800000",
    "number": "1710858436",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 BROOKTRAIL CT",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954092763",
            "telephone_number": "707-778-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949542339",
            "telephone_number": "707-778-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THISSEN",
        "first_name": "TAMARA",
        "middle_name": "JANE",
        "credential": "BSN, RN-C, CEN, AMB-",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-16",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WE0003X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Emergency",
            "state": "CA",
            "license": "725175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petaluma, CA

Sources for this page

Verify at the official NPI Registry.