Provider Demographics
NPI:1851340491
Name:TACIA, SIDNI ANNA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SIDNI
Middle Name:ANNA
Last Name:TACIA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7835 US HIGHWAY 23 S
Mailing Address - Street 2:APT 1
Mailing Address - City:OSSINEKE
Mailing Address - State:MI
Mailing Address - Zip Code:49766-9612
Mailing Address - Country:US
Mailing Address - Phone:989-750-2898
Mailing Address - Fax:
Practice Address - Street 1:180 N STATE AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2847
Practice Address - Country:US
Practice Address - Phone:989-356-8720
Practice Address - Fax:989-356-8707
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201260363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIVAD000Medicare UPIN
NCS72169Medicare UPIN