Provider Demographics
NPI:1487654976
Name:YATES, TANA H (CRNP-A)
Entity Type:Individual
Prefix:MS
First Name:TANA
Middle Name:H
Last Name:YATES
Suffix:
Gender:F
Credentials:CRNP-A
Other - Prefix:MS
Other - First Name:TANA
Other - Middle Name:H
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP-A
Mailing Address - Street 1:PO BOX 64294
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4294
Mailing Address - Country:US
Mailing Address - Phone:410-280-6573
Mailing Address - Fax:410-280-6515
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:443-481-5300
Practice Address - Fax:443-481-6705
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162103208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP00347745OtherRR MEDICARE
DC0006OtherCAREFIRST BCBS
MD64282101OtherCAREFIRST BCBS
MDJ871Medicare PIN
DC0006OtherCAREFIRST BCBS