Provider Demographics
NPI:1558043216
Name:MCCULLAR, TANYA ROSEANNA (CNA)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:ROSEANNA
Last Name:MCCULLAR
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:ROSEANNA
Other - Last Name:NCCULLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:3880 S BECKLEY AVE APT 4202
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75224-4680
Mailing Address - Country:US
Mailing Address - Phone:469-657-6088
Mailing Address - Fax:
Practice Address - Street 1:3880 S BECKLEY AVE APT 4202
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-4680
Practice Address - Country:US
Practice Address - Phone:469-657-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty