Provider Demographics
NPI:1154812899
Name:BRAUTIGAM, TANYA (FNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BRAUTIGAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-791-2520
Mailing Address - Fax:717-703-0061
Practice Address - Street 1:4310 LONDONDERRY RD STE 209
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-5329
Practice Address - Country:US
Practice Address - Phone:717-791-2520
Practice Address - Fax:717-703-0061
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP018887363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily