Provider Demographics
NPI:1689454217
Name:ROBINSON, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ROBINSON
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 1:2360 SOULT ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-2259
Mailing Address - Country:US
Mailing Address - Phone:985-237-9750
Mailing Address - Fax:
Practice Address - Street 1:2360 SOULT ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-2259
Practice Address - Country:US
Practice Address - Phone:985-237-9750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA93502376K00000X
LA011288940172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No376K00000XNursing Service Related ProvidersNurse's Aide