Provider Demographics
NPI:1073503454
Name:SHINOHARA, TANIA (NP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:SHINOHARA
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 1:15320 HIGHWAY 105 W STE 120
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-2602
Mailing Address - Country:US
Mailing Address - Phone:936-582-5660
Mailing Address - Fax:936-582-5661
Practice Address - Street 1:15320 HIGHWAY 105 W STE 105
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-2602
Practice Address - Country:US
Practice Address - Phone:936-582-5660
Practice Address - Fax:936-582-5661
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164522363L00000X
TXAP125195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073503454Medicaid
VAP00287956OtherRAILROAD MEDICARE
P26651Medicare UPIN
VA1073503454Medicaid