Provider Demographics
NPI:1063561181
Name:MONCIER, TANITHA MARIE (APRN-CNP)
Entity type:Individual
Prefix:
First Name:TANITHA
Middle Name:MARIE
Last Name:MONCIER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 W NORTHFIELD BLVD STE 3B
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2884
Mailing Address - Country:US
Mailing Address - Phone:615-994-1468
Mailing Address - Fax:615-526-6488
Practice Address - Street 1:1535 W NORTHFIELD BLVD STE 3B
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2884
Practice Address - Country:US
Practice Address - Phone:615-994-1468
Practice Address - Fax:615-526-6488
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10468363LF0000X
ME121116363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010276859Medicaid