Provider Demographics
NPI:1619343803
Name:BUSH, TANYA F (APRN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:F
Last Name:BUSH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:F
Other - Last Name:DUNCAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6328
Mailing Address - Country:US
Mailing Address - Phone:910-219-8326
Mailing Address - Fax:910-939-4269
Practice Address - Street 1:5710 OLEANDER DR STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4722
Practice Address - Country:US
Practice Address - Phone:910-799-1810
Practice Address - Fax:910-939-4269
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000020158363LP0808X
NC5011389363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health