Provider Demographics
NPI:1598010068
Name:VANPELT, TANIA (CNA)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:VANPELT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86317 MACAW RD
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-3719
Mailing Address - Country:US
Mailing Address - Phone:904-225-3635
Mailing Address - Fax:708-294-1690
Practice Address - Street 1:86317 MACAW RD
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-3719
Practice Address - Country:US
Practice Address - Phone:904-225-3635
Practice Address - Fax:708-294-1690
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 245817376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide