Provider Demographics
NPI:1144419235
Name:BROOKS, TANYA KIMBROUGH (RN)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:KIMBROUGH
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HENRY PKWY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6636
Mailing Address - Country:US
Mailing Address - Phone:770-898-7423
Mailing Address - Fax:770-898-7412
Practice Address - Street 1:139 HENRY PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6636
Practice Address - Country:US
Practice Address - Phone:770-898-7423
Practice Address - Fax:770-898-7412
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN181028163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse