Provider Demographics
NPI:1417336348
Name:RENNIE, TANYA (RN, APRN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:RENNIE
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 ST JAMES PL
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-4082
Mailing Address - Country:US
Mailing Address - Phone:405-387-2208
Mailing Address - Fax:405-387-3430
Practice Address - Street 1:505 ST JAMES PL
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-4082
Practice Address - Country:US
Practice Address - Phone:405-387-2208
Practice Address - Fax:405-387-3430
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0105571163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse