Provider Demographics
NPI:1013001973
Name:WILCOX, TANYA S (NP)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:S
Last Name:WILCOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 DENNIS KEMP LN NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3938
Mailing Address - Country:US
Mailing Address - Phone:770-515-9000
Mailing Address - Fax:
Practice Address - Street 1:1770 DENNIS KEMP LN NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3938
Practice Address - Country:US
Practice Address - Phone:770-515-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143313363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics