Provider Demographics
NPI:1326404799
Name:WELLS, TANGECA (FNP-C)
Entity Type:Individual
Prefix:
First Name:TANGECA
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20987 N JOHN WAYNE PKWY # B104-415
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85139-2926
Mailing Address - Country:US
Mailing Address - Phone:602-885-0329
Mailing Address - Fax:
Practice Address - Street 1:19756 N JOHN WAYNE PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8513
Practice Address - Country:US
Practice Address - Phone:602-885-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-14
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN194263163W00000X
AZAP8380363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse