Provider Demographics
NPI:1720572357
Name:SWEAT, TANITA (MSN, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TANITA
Middle Name:
Last Name:SWEAT
Suffix:
Gender:F
Credentials:MSN, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 AYRSLEY TOWN BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4068
Mailing Address - Country:US
Mailing Address - Phone:704-727-7008
Mailing Address - Fax:704-774-6922
Practice Address - Street 1:2412 E VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3665
Practice Address - Country:US
Practice Address - Phone:757-937-8173
Practice Address - Fax:757-937-8308
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1130565363LF0000X
VA0024176357363LF0000X, 363LP0808X
VA2021102568363LP0808X
NC5018833363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily