Provider Demographics
NPI:1568964062
Name:BUNCH, TANYA LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNN
Last Name:BUNCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:LYNN
Other - Last Name:HALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1703 INNOVATION DR STE 3136
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-8815
Mailing Address - Country:US
Mailing Address - Phone:717-741-3449
Mailing Address - Fax:717-741-5496
Practice Address - Street 1:1703 INNOVATION DR STE 3136
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8815
Practice Address - Country:US
Practice Address - Phone:717-741-3449
Practice Address - Fax:717-741-5496
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant