Provider Demographics
NPI:1245591973
Name:TAZI, ANYINKENG LYDIA (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ANYINKENG
Middle Name:LYDIA
Last Name:TAZI
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12003 PISCATAWAY RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1168
Mailing Address - Country:US
Mailing Address - Phone:240-691-6835
Mailing Address - Fax:
Practice Address - Street 1:12003 PISCATAWAY RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1168
Practice Address - Country:US
Practice Address - Phone:240-691-6835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1031555163W00000X
251S00000X, 374U00000X
MDR208066363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No251S00000XAgenciesCommunity/Behavioral Health
No374U00000XNursing Service Related ProvidersHome Health Aide