Provider Demographics
NPI:1063986479
Name:TANGUAY, ROSARIO (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:TANGUAY
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LIB-LEGACY LANSING -MI, MI,
Mailing Address - Street 2:4136 LEGACY PARKWAY
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911
Mailing Address - Country:US
Mailing Address - Phone:517-492-0784
Mailing Address - Fax:517-913-6267
Practice Address - Street 1:4136 LEGACY PKWY
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4265
Practice Address - Country:US
Practice Address - Phone:517-492-0517
Practice Address - Fax:517-882-3633
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704295379363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care