Provider Demographics
NPI:1407649239
Name:SMITH, TANYA A
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 DANVERS ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-3001
Mailing Address - Country:US
Mailing Address - Phone:352-973-3154
Mailing Address - Fax:
Practice Address - Street 1:609 DANVERS ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-3001
Practice Address - Country:US
Practice Address - Phone:352-973-3154
Practice Address - Fax:407-368-6468
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-24
Last Update Date:2025-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care