Provider Demographics
NPI:1760843304
Name:BUREY MCLEAN, TANIA (ARNP)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:BUREY MCLEAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:BUREY MCLEAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:4182 SW BAIRD ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3136
Mailing Address - Country:US
Mailing Address - Phone:561-714-6059
Mailing Address - Fax:
Practice Address - Street 1:4182 SW BAIRD ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3136
Practice Address - Country:US
Practice Address - Phone:561-714-6059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9235488363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner