Provider Demographics
NPI:1659839918
Name:CROWELL, TANYA (NP-C)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:CROWELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38127-7734
Mailing Address - Country:US
Mailing Address - Phone:901-358-0326
Mailing Address - Fax:901-356-9010
Practice Address - Street 1:943 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38127-7734
Practice Address - Country:US
Practice Address - Phone:901-358-0326
Practice Address - Fax:901-358-9010
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily