Provider Demographics
NPI:1407866395
Name:GONZALEZ, TANA L (CRNP)
Entity Type:Individual
Prefix:MS
First Name:TANA
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TANA
Other - Middle Name:L
Other - Last Name:PHIPPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2350 FREEDOM WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-8200
Mailing Address - Country:US
Mailing Address - Phone:717-741-9537
Mailing Address - Fax:
Practice Address - Street 1:2350 FREEDOM WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8200
Practice Address - Country:US
Practice Address - Phone:717-741-9537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP005976H363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health