Provider Demographics
NPI:1013201177
Name:COUTU, TANYA ANN (FNP-BC, RN)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:ANN
Last Name:COUTU
Suffix:
Gender:F
Credentials:FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BARTLETT ST STE 108
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1300
Mailing Address - Country:US
Mailing Address - Phone:978-453-1811
Mailing Address - Fax:978-452-9111
Practice Address - Street 1:33 BARTLETT ST STE 108
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1300
Practice Address - Country:US
Practice Address - Phone:978-453-1811
Practice Address - Fax:978-452-9111
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN255877363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily