Provider Demographics
NPI:1326512732
Name:MIMS, TANYA LYNN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LYNN
Last Name:MIMS
Suffix:
Gender:F
Credentials:FNP-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1120 15TH ST
Mailing Address - Street 2:BG-1019
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-3531
Mailing Address - Fax:706-721-2527
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:BG-1019
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3531
Practice Address - Fax:706-721-2527
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN154277363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily