Provider Demographics
NPI:1881163590
Name:KLOTZ, TANYA (APRN-FNP-CB)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:KLOTZ
Suffix:
Gender:F
Credentials:APRN-FNP-CB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 PARK BLVD APT 705
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33777-4125
Mailing Address - Country:US
Mailing Address - Phone:727-301-4730
Mailing Address - Fax:
Practice Address - Street 1:3641 TYRONE BLVD N STE 3
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1150
Practice Address - Country:US
Practice Address - Phone:727-301-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-26
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9335527163W00000X
FL11000535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse