Provider Demographics
NPI:1083900658
Name:MOFFITT, TANYA LYNN
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:LYNN
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 140TH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:IA
Mailing Address - Zip Code:50036-7321
Mailing Address - Country:US
Mailing Address - Phone:515-230-4020
Mailing Address - Fax:
Practice Address - Street 1:1662 140TH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:IA
Practice Address - Zip Code:50036-7321
Practice Address - Country:US
Practice Address - Phone:515-230-4020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker