Provider Demographics
NPI:1639879315
Name:STARKE, TANYA C
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:C
Last Name:STARKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7893 VERMEIL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2041
Mailing Address - Country:US
Mailing Address - Phone:804-243-8767
Mailing Address - Fax:
Practice Address - Street 1:7893 VERMEIL ST
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23237-2041
Practice Address - Country:US
Practice Address - Phone:804-243-8767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management