Provider Demographics
NPI:1336759943
Name:SMITH, TANYA RENEE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:RENEE
Other - Last Name:WOULARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:13105 ELK MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7184
Mailing Address - Country:US
Mailing Address - Phone:813-681-6537
Mailing Address - Fax:
Practice Address - Street 1:13105 ELK MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7184
Practice Address - Country:US
Practice Address - Phone:813-681-6537
Practice Address - Fax:813-741-1204
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107791100Medicaid
FL4DQ14OtherBLUE CROSS BLUE SHIELD