Provider Demographics
NPI:1598508962
Name:STEPHENS, TANEEKA (FNP)
Entity type:Individual
Prefix:
First Name:TANEEKA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5592 POYDASHEFF CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-6885
Mailing Address - Country:US
Mailing Address - Phone:706-580-0228
Mailing Address - Fax:
Practice Address - Street 1:18 9TH ST STE 514
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2726
Practice Address - Country:US
Practice Address - Phone:601-207-3959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCO-000003363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily