Provider Demographics
NPI:1780865345
Name:ANDERSON, TANYA (AGPCNP)
Entity Type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 BEECH GROVE LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8393
Mailing Address - Country:US
Mailing Address - Phone:704-249-9098
Mailing Address - Fax:
Practice Address - Street 1:9103 FRANKLIN SQUARE DR STE 305
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3939
Practice Address - Country:US
Practice Address - Phone:443-777-7608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC249171363LA2200X
GARN166594363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health