Provider Demographics
NPI:1942646740
Name:QUARLES, TANYA NICHOLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:NICHOLE
Last Name:QUARLES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:TANYA
Other - Middle Name:NICHOLE
Other - Last Name:JASMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3 PAR DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:SC
Mailing Address - Zip Code:29832-2729
Mailing Address - Country:US
Mailing Address - Phone:803-275-1752
Mailing Address - Fax:803-275-1751
Practice Address - Street 1:3 PAR DR
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:SC
Practice Address - Zip Code:29832-2729
Practice Address - Country:US
Practice Address - Phone:803-275-1752
Practice Address - Fax:803-275-1751
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)