Provider Demographics
NPI:1235830365
Name:QUARLES, TANJA MAKENZIE (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TANJA
Middle Name:MAKENZIE
Last Name:QUARLES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7628 NE 121ST LN UNIT 2
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2447
Mailing Address - Country:US
Mailing Address - Phone:978-210-2255
Mailing Address - Fax:
Practice Address - Street 1:7628 NE 121ST LN UNIT 2
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-2447
Practice Address - Country:US
Practice Address - Phone:978-210-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61464829363LP0808X
WARN61174885163W00000X
MARN2325621163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse