Provider Demographics
NPI:1255082749
Name:ROSS, TANYA JOYCE (CRNP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:JOYCE
Last Name:ROSS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-2025
Mailing Address - Country:US
Mailing Address - Phone:410-553-8273
Mailing Address - Fax:410-255-4370
Practice Address - Street 1:3708 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-2025
Practice Address - Country:US
Practice Address - Phone:410-553-8273
Practice Address - Fax:410-255-4370
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty