Provider Demographics
NPI:1689208217
Name:BARDSLEY, TANIA LALLI (CRNA)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:LALLI
Last Name:BARDSLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:ARAUJO
Other - Last Name:LALLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5820 FARRINGTON RD APT 102
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7012
Mailing Address - Country:US
Mailing Address - Phone:623-262-0212
Mailing Address - Fax:
Practice Address - Street 1:1121 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1007
Practice Address - Country:US
Practice Address - Phone:336-832-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-22
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC286629163W00000X
390200000X
NC138555367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program