Provider Demographics
NPI:1427738418
Name:MCDONALD, TANGANIKA PAUL (CNA)
Entity type:Individual
Prefix:MRS
First Name:TANGANIKA
Middle Name:PAUL
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 HIDDEN CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5267
Mailing Address - Country:US
Mailing Address - Phone:478-867-9143
Mailing Address - Fax:
Practice Address - Street 1:205 THOMAS BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3235
Practice Address - Country:US
Practice Address - Phone:855-203-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028910673253Z00000X
GA22-1768246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy