Provider Demographics
NPI:1205859451
Name:RAEF, TANYA JANE (ANP)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:JANE
Last Name:RAEF
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:JANE
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-689-5600
Mailing Address - Fax:757-579-8532
Practice Address - Street 1:2006 HEALTH CAMPUS DR
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8679
Practice Address - Country:US
Practice Address - Phone:540-689-5600
Practice Address - Fax:757-579-8532
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN13911363LA2100X, 363LA2100X
VA0024177701363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4352409OtherBCBS
TN1514749Medicaid
KY7100158680Medicaid
TN1514749Medicaid