Provider Demographics
NPI:1184268138
Name:TANQUARY, TAYLOR STEVEN
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:STEVEN
Last Name:TANQUARY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 MONTGOMERY BLVD NE
Mailing Address - Street 2:STE 6
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1291
Mailing Address - Country:US
Mailing Address - Phone:530-559-8658
Mailing Address - Fax:
Practice Address - Street 1:8647 CHILI HILL RD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:CA
Practice Address - Zip Code:95658-9657
Practice Address - Country:US
Practice Address - Phone:530-559-8658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-02
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD181729367500000X
NMCRNA-59374367500000X
CA835992163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse