Provider Demographics
NPI:1780980615
Name:PIKE, TANYA JEAN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:JEAN
Last Name:PIKE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SUN TEMPLE DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-5924
Mailing Address - Country:US
Mailing Address - Phone:256-774-5524
Mailing Address - Fax:256-774-5523
Practice Address - Street 1:400 SUN TEMPLE DR.
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-774-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-10
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALCRNP1-194303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY07J1OtherBCBS
FL003418700Medicaid
FLEV042ZMedicare PIN