Provider Demographics
NPI:1801334594
Name:WEST, TANYA ELIZABETH (ARNP)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:ELIZABETH
Last Name:WEST
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 1:11353 NETTLEBROOK ST E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-1006
Mailing Address - Country:US
Mailing Address - Phone:904-874-4710
Mailing Address - Fax:
Practice Address - Street 1:3229 BEAR RUN BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-7334
Practice Address - Country:US
Practice Address - Phone:904-529-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9314111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily