Provider Demographics
NPI:1316720329
Name:LEAF, TANIA TERESA (PMHNP)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:TERESA
Last Name:LEAF
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:
Other - Last Name:GROBARCHIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6025 W LAPHAM ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-5020
Mailing Address - Country:US
Mailing Address - Phone:414-640-6605
Mailing Address - Fax:
Practice Address - Street 1:5000 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53295-0001
Practice Address - Country:US
Practice Address - Phone:414-384-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11878-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health