Provider Demographics
NPI:1396178281
Name:CROSS, TANYA MADDOX (RN)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:MADDOX
Last Name:CROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-3538
Mailing Address - Country:US
Mailing Address - Phone:843-745-2183
Mailing Address - Fax:843-745-2182
Practice Address - Street 1:75 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-3538
Practice Address - Country:US
Practice Address - Phone:843-745-2183
Practice Address - Fax:843-745-2182
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC90070163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool