Provider Demographics
NPI:1306834403
Name:BANKS, TANYA ERNEST (ARNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ERNEST
Last Name:BANKS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 W NEWBERRY RD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4381
Mailing Address - Country:US
Mailing Address - Phone:352-333-5500
Mailing Address - Fax:352-333-5506
Practice Address - Street 1:6440 W NEWBERRY RD
Practice Address - Street 2:SUITE 402
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4381
Practice Address - Country:US
Practice Address - Phone:352-333-5500
Practice Address - Fax:352-333-5506
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3059782363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303565400Medicaid