Provider Demographics
NPI:1679942478
Name:OLIVER, TANIA (NP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:OLIVER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4785 VENTURA DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-2422
Mailing Address - Country:US
Mailing Address - Phone:734-751-5885
Mailing Address - Fax:
Practice Address - Street 1:1854 W AUBURN RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-3868
Practice Address - Country:US
Practice Address - Phone:248-696-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704260324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily