Provider Demographics
NPI:1225549793
Name:ENZ, TATHA MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TATHA
Middle Name:MARIE
Last Name:ENZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 N 2000 E
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84040-2305
Mailing Address - Country:US
Mailing Address - Phone:801-721-0334
Mailing Address - Fax:
Practice Address - Street 1:1951 N 2000 E
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-2305
Practice Address - Country:US
Practice Address - Phone:801-721-0334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT216202-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily