Black, Tanya J

Black, Tanya J is an individual health care provider with primary practice located at 4801 Veterans Dr St Cloud Vahcs, St Cloud MN 56303. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Black, Tanya J can be contacted via phone (320) 252-1670.

Contact Information

Primary practice address
4801 Veterans Dr St Cloud Vahcs St Cloud MN 56303
Phone: (320) 252-1670
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 2006005172 Minnesota

Profile Details

NPI number 1770680894
LBN Legal business name Black, Tanya J
Credentials APRN, BC
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 20th, 2006
Last updated Jan 26th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770680894 NPPES
Minnesota MEDICAID 71612000

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