Provider Demographics
NPI:1750855599
Name:MILLER, TANYA D (FAMILY NURSE PRACTIT)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 SIERRA ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31503-9232
Mailing Address - Country:US
Mailing Address - Phone:912-550-9277
Mailing Address - Fax:
Practice Address - Street 1:1724A OLD REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-1036
Practice Address - Country:US
Practice Address - Phone:912-283-1359
Practice Address - Fax:912-283-1360
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183525163WG0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice