Provider Demographics
NPI:1982179412
Name:FUNKE, TANYA ANGELA (FNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:ANGELA
Last Name:FUNKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 LAUREL VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LAKEHILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78063-6389
Mailing Address - Country:US
Mailing Address - Phone:830-751-3330
Mailing Address - Fax:
Practice Address - Street 1:146 LAUREL VISTA DR
Practice Address - Street 2:
Practice Address - City:LAKEHILLS
Practice Address - State:TX
Practice Address - Zip Code:78063-6389
Practice Address - Country:US
Practice Address - Phone:830-751-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily