Provider Demographics
NPI:1467603167
Name:SALINE, TANA K (PA)
Entity Type:Individual
Prefix:
First Name:TANA
Middle Name:K
Last Name:SALINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:TANA
Other - Middle Name:K
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4580 STEPHENS CIR NW STE 202
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3645
Mailing Address - Country:US
Mailing Address - Phone:330-754-4431
Mailing Address - Fax:303-244-8839
Practice Address - Street 1:4580 STEPHENS CIR NW STE 202
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3645
Practice Address - Country:US
Practice Address - Phone:303-754-4431
Practice Address - Fax:330-499-3056
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
50.003366RX363A00000X
PAOA002310363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA138104Medicare PIN