Provider Demographics
NPI:1679351431
Name:KNOX, TANNETTE MONACO (PA-C)
Entity Type:Individual
Prefix:
First Name:TANNETTE
Middle Name:MONACO
Last Name:KNOX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14490 OCEAN HWY
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-4821
Mailing Address - Country:US
Mailing Address - Phone:843-881-4440
Mailing Address - Fax:
Practice Address - Street 1:8208 DEVON CT
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4178
Practice Address - Country:US
Practice Address - Phone:760-670-6971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical