Provider Demographics
NPI:1912903337
Name:KIRK, TANYA L (FNP)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:L
Last Name:KIRK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 RHONE CIRCLE
Mailing Address - Street 2:ST 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-561-5152
Mailing Address - Fax:907-562-2585
Practice Address - Street 1:3730 RHONE CIRCLE
Practice Address - Street 2:ST 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-561-5152
Practice Address - Fax:907-562-2585
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK782363LF0000X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP6477Medicaid
AKNP6477Medicare UPIN