Provider Demographics
NPI:1699799684
Name:MARIN, TANYA VERONICA (DNP, APRN, CPNP-PC/A)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:VERONICA
Last Name:MARIN
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6241 SNOWHEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3801
Mailing Address - Country:US
Mailing Address - Phone:915-740-4344
Mailing Address - Fax:
Practice Address - Street 1:1245 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9743
Practice Address - Country:US
Practice Address - Phone:575-332-4633
Practice Address - Fax:575-332-4635
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02627363LP0200X
TX644173363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX644173OtherNURSE PRACTITIONERS
NM42850002Medicaid