Provider Demographics
NPI:1275998106
Name:BREWER, TANYA LYNN (MSN, RN, PNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LYNN
Last Name:BREWER
Suffix:
Gender:F
Credentials:MSN, RN, PNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 SHOOKS LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3087
Mailing Address - Country:US
Mailing Address - Phone:815-742-6285
Mailing Address - Fax:
Practice Address - Street 1:1715 N WEBER ST
Practice Address - Street 2:SUITE 120
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7532
Practice Address - Country:US
Practice Address - Phone:719-602-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0992128-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics