Provider Demographics
NPI:1982486163
Name:GIPSON, TANYA GLASS (RN)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:GLASS
Last Name:GIPSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:JEUNESE
Other - Last Name:GLASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9141 STONEDALE DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7502
Mailing Address - Country:US
Mailing Address - Phone:901-355-1361
Mailing Address - Fax:
Practice Address - Street 1:1030 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-2127
Practice Address - Country:US
Practice Address - Phone:901-523-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000103271163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse