Provider Demographics
NPI:1316557044
Name:BOATWRIGHT, TANYA (CNA)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:BOATWRIGHT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 754
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-0754
Mailing Address - Country:US
Mailing Address - Phone:904-844-1467
Mailing Address - Fax:
Practice Address - Street 1:502 WOODED CROSSING CIR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-6548
Practice Address - Country:US
Practice Address - Phone:904-844-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA133486376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide