Provider Demographics
NPI:1104384924
Name:NEVADA HEALTH TANITA PLLC
Entity Type:Organization
Organization Name:NEVADA HEALTH TANITA PLLC
Other - Org Name:HENDERSON WOMEN'S CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BARSTOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-847-6252
Mailing Address - Street 1:650 S GREEN VALLEY PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-0425
Mailing Address - Country:US
Mailing Address - Phone:702-847-6252
Mailing Address - Fax:702-847-6254
Practice Address - Street 1:650 S GREEN VALLEY PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-0425
Practice Address - Country:US
Practice Address - Phone:702-847-6252
Practice Address - Fax:702-847-6254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250009085Medicaid