Provider Demographics
NPI:1396512950
Name:GAYLES, TANEISHA PATRICE (FNP)
Entity type:Individual
Prefix:
First Name:TANEISHA
Middle Name:PATRICE
Last Name:GAYLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GOLD LEAF PL
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6807
Mailing Address - Country:US
Mailing Address - Phone:757-602-5551
Mailing Address - Fax:
Practice Address - Street 1:702 CITY CENTER BLVD STE C
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3096
Practice Address - Country:US
Practice Address - Phone:757-679-6058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188735363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily