Provider Demographics
NPI:1952678773
Name:RAUSCH, TANYA-ANN MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:TANYA-ANN
Middle Name:MARIE
Last Name:RAUSCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TANYA-ANN
Other - Middle Name:MARIE
Other - Last Name:O'SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:
Practice Address - Street 1:603 N FLAMINGO RD STE 255
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1013
Practice Address - Country:US
Practice Address - Phone:954-844-0831
Practice Address - Fax:954-276-0268
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9229810363LA2200X
FLAPRN9229810363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022626900Medicaid