Provider Demographics
NPI:1114986106
Name:POISKER, TANYA X (CRNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:X
Last Name:POISKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 SWEETBAY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1428
Mailing Address - Country:US
Mailing Address - Phone:410-334-3788
Mailing Address - Fax:410-334-3599
Practice Address - Street 1:1820 SWEETBAY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1428
Practice Address - Country:US
Practice Address - Phone:410-334-3788
Practice Address - Fax:410-334-3599
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR126928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD816MK629Medicare ID - Type Unspecified
MDS89325Medicare UPIN