Independent US Healthcare Provider Directory & Public Medical Database
Active NPI 1245100668 Individual Practitioner Female Practitioner

Deranee Pearl G Tabor

Licensed Practical Nurse • Lodi, CA

Professional Overview & Biography Verified Profile Summary

Deranee Pearl Tabor is a registered healthcare professional specializing in Licensed Practical Nurse in Lodi, CA. Practice services are available at 541 S HAM LN STE A&B under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

541 S Ham Ln Ste A&b

Lodi, CA 952423059

Telephone 2092248940
Associated Practice Facility / Clinic
🏢 Aegis Treatment Centers, Llc Facility NPI 1649669979

Specialty Benchmarks & Practice Insights

Comparative analytics for Licensed Practical Nurse in Lodi, CA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 17.9 Yrs
Regional Practice Density
1 Specialists

Practicing in Lodi, CA (440 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2025-12-03
Licensed Practical Nurse Primary Specialty

NUCC Taxonomy Code: 164W00000X

State License CA 704752

An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

32 Associated Practitioners
Esperanza Gonzales

Counselor - Addiction (Substance Use Disorder)

NPI 1003421314
David Canton

Counselor - Addiction (Substance Use Disorder)

NPI 1023815529
Carol Jacinto

Counselor - Addiction (Substance Use Disorder)

NPI 1033327358
Jennifer Preap

Counselor - Addiction (Substance Use Disorder)

NPI 1043866627
Marci Patrick

Licensed Vocational Nurse

NPI 1083260780
Kathryn Trunnell , CATC

Counselor - Addiction (Substance Use Disorder)

NPI 1093032559

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active December 03, 2025

NPI status registered as active in NPPES database

📍
Updated Practice Location December 03, 2025

Registered at 541 S HAM LN STE A&B, LODI, CA 952423059 (Tel: 2092248940)

📍
Updated Business Mailing Address December 03, 2025

Registered at 541 S HAM LN STE A&B, LODI, CA 952423059 (Tel: 2092248940)

👤
Provider Name / Credentials Updated December 03, 2025

Recorded as DERANEE PEARL TABOR

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 03, 2025

Licensed Practical Nurse (License #704752 in CA)

🟢
Initial NPI Registration & Enumeration November 10, 2025

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1245100668
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 10, 2025
Last Update: December 03, 2025
Sole Proprietor: No

Mailing Address

541 S Ham Ln Ste A&b

Lodi, CA 952423059

Phone: 2092248940

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.