Provider Demographics
NPI:1265778047
Name:GERACI, TANYA S (APRN)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:S
Last Name:GERACI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 NEW LA GRANGE RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4700
Mailing Address - Country:US
Mailing Address - Phone:502-434-7050
Mailing Address - Fax:844-223-9413
Practice Address - Street 1:8013 NEW LA GRANGE RD
Practice Address - Street 2:SUITE 5
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4700
Practice Address - Country:US
Practice Address - Phone:502-434-7050
Practice Address - Fax:844-223-9413
Is Sole Proprietor?:No
Enumeration Date:2012-12-23
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3007544363LF0000X
IN28214678A364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily