Provider Demographics
NPI:1396431839
Name:SMITH, TANYA YVETTE (CNA, CEO)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:YVETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:CNA, CEO
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 1035
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-0114
Mailing Address - Country:US
Mailing Address - Phone:717-982-9733
Mailing Address - Fax:
Practice Address - Street 1:318 SUSQUEHANNA ST APT 5
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4535
Practice Address - Country:US
Practice Address - Phone:717-982-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA699553501374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty