Provider Demographics
NPI:1477828853
Name:PITTMAN, TANJA ANNETTE (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TANJA
Middle Name:ANNETTE
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 N BLACKWELDER AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-1402
Mailing Address - Country:US
Mailing Address - Phone:501-269-0041
Mailing Address - Fax:
Practice Address - Street 1:2501 N BLACKWELDER AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-1402
Practice Address - Country:US
Practice Address - Phone:501-269-0041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-18
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03660363LF0000X
OKR102354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1477828853OtherNPI