Provider Demographics
NPI:1013913797
Name:BRONZELL-WYNDER, TANYA MONIQUE (DNP, CRNP)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:MONIQUE
Last Name:BRONZELL-WYNDER
Suffix:
Gender:F
Credentials:DNP, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1302
Mailing Address - Country:US
Mailing Address - Phone:215-707-5864
Mailing Address - Fax:215-707-6867
Practice Address - Street 1:433 N 7TH ST FL 1
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08102-2212
Practice Address - Country:US
Practice Address - Phone:856-288-9115
Practice Address - Fax:856-379-4286
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013200363LA2100X
PASP008348363LA2200X
NJ26NJ00600900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102679121Medicaid
PA102679121Medicaid
PAQ37819Medicare UPIN