Provider Demographics
NPI:1881694123
Name:DUFFEY-WARNER, TANYA (ARNP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:DUFFEY-WARNER
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 1:125 BAPTIST WAY STE 3A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2274
Mailing Address - Country:US
Mailing Address - Phone:448-227-6604
Mailing Address - Fax:850-857-1747
Practice Address - Street 1:125 BAPTIST WAY STE 3A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2274
Practice Address - Country:US
Practice Address - Phone:448-227-6604
Practice Address - Fax:850-857-1747
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-077795363LF0000X
FLARNP1364942363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL161820Medicaid
FL330705300Medicaid
FLY6915ZMedicare PIN
FL330705300Medicaid