Individual provider Active NPI

Tatiana Eloisa Huezo, FNP-C

  • Family Nurse Practitioner
  • Sausalito, CA
National Provider Identifier
1750048260
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95018460 Issued in CA
Practice address
3 Harbor Dr Ste 111
Sausalito, CA 94965
Phone
(415) 683-2988
Fax
(415) 683-2980
NPI assigned
Nov 18, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95018460 CA Primary

Addresses

Primary practice location

3 Harbor Dr Ste 111
Sausalito, CA 94965

Mailing address

3 Harbor Dr Ste 111
Sausalito, CA 94965
Phone (415) 683-2988

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240213004088 CA Practitioner - Nurse Practitioner 2769826163 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Regents Univ of California UCSFGroup PAC ID 6305160300, 276 clinicians

Practice addresses (Care Compare)

505 Parnassus Ave
San Francisco, CA 94143-2204
Phone (415) 476-1000

Hospital & facility affiliations

  • Carelink Home Health Agency LLC Home health agency, Burlingame, CA, CCN 059364
  • Marinhealth Medical Center Hospital, Greenbrae, CA, CCN 050360
  • Novato Community Hospital Hospital, Novato, CA, CCN 050131

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95018460CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regents Univ of California UCSF CurrentSince Jan 31, 2024 Accepting new patients
Regents of the University of California - UCSF Past Accepting new patients

Locations

1100 Larkspur Landing Cir
Ste 10
Larkspur, CA 94939
Phone (415) 464-1350

505 Parnassus Ave
San Francisco, CA 94143
Phone (415) 476-9058

3 Harbor Dr
Ste 111
Sausalito, CA 94965
Phone (415) 683-2988

Interoperability endpoints

  • Direct secure messaging: thuezo332661@direct-ucsfmedicalcenter.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1637193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1750048260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 HARBOR DR STE 111",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "94965",
            "telephone_number": "415-683-2988",
            "fax_number": "415-683-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 HARBOR DR STE 111",
            "city": "SAUSALITO",
            "state": "CA",
            "postal_code": "94965",
            "telephone_number": "415-683-2988",
            "fax_number": "415-683-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUEZO",
        "first_name": "TATIANA",
        "middle_name": "ELOISA",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-11-18",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95018460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sausalito, CA

Sources for this page

Verify at the official NPI Registry.