Provider Demographics
NPI:1194466375
Name:WESLEY, TANISHA N (APRN)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:N
Last Name:WESLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6039 CYPRESS GARDENS BLVD # 591
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-4115
Mailing Address - Country:US
Mailing Address - Phone:863-608-4635
Mailing Address - Fax:
Practice Address - Street 1:408 SMILEY CT
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-3831
Practice Address - Country:US
Practice Address - Phone:863-608-4635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily