Provider Demographics
NPI:1275071755
Name:GOLDEN, TANYA MARIE (NP-C)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MARIE
Last Name:GOLDEN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 PERSHING HWY
Mailing Address - Street 2:
Mailing Address - City:SMACKOVER
Mailing Address - State:AR
Mailing Address - Zip Code:71762-2300
Mailing Address - Country:US
Mailing Address - Phone:870-725-3471
Mailing Address - Fax:870-725-3041
Practice Address - Street 1:3108 N WEST AVE
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730-2731
Practice Address - Country:US
Practice Address - Phone:870-918-1701
Practice Address - Fax:870-863-9020
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily