Provider Demographics
NPI:1760006886
Name:CALVERT, TANI REYNOLDS (AGACNP)
Entity Type:Individual
Prefix:MS
First Name:TANI
Middle Name:REYNOLDS
Last Name:CALVERT
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:MS
Other - First Name:TANI
Other - Middle Name:
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1923 S UTICA AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-6520
Mailing Address - Country:US
Mailing Address - Phone:918-744-2868
Mailing Address - Fax:918-403-6348
Practice Address - Street 1:1923 S UTICA AVE FL 4
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-6520
Practice Address - Country:US
Practice Address - Phone:918-744-2868
Practice Address - Fax:918-403-6348
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK94325364SG0600X
OKR0094325363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology