Provider Demographics
NPI:1356427918
Name:SPOON, TANYA L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:L
Last Name:SPOON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98337-0507
Mailing Address - Country:US
Mailing Address - Phone:360-621-2696
Mailing Address - Fax:844-602-4646
Practice Address - Street 1:1100 WHEATON WAY
Practice Address - Street 2:SUITE F AND G
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-4459
Practice Address - Country:US
Practice Address - Phone:360-621-2696
Practice Address - Fax:844-602-4646
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007455363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8947504OtherGROUP PTAN
WA9650441Medicaid
WAG8864172Medicare PIN
G8947505Medicare UPIN