Provider Demographics
NPI:1760079800
Name:ROANE-STILL, TAWANNA LATOYA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:TAWANNA
Middle Name:LATOYA
Last Name:ROANE-STILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:TAWANNA
Other - Middle Name:LATOYA
Other - Last Name:ROANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:2109 FAIRBURN RD STE A
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1037
Mailing Address - Country:US
Mailing Address - Phone:770-726-7958
Mailing Address - Fax:
Practice Address - Street 1:2109 FAIRBURN RD STE A
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1037
Practice Address - Country:US
Practice Address - Phone:770-726-7958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN097610164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse