Provider Demographics
NPI:1720064835
Name:BRYNDZIA, TANYA THERESA (CNP)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:THERESA
Last Name:BRYNDZIA
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 LAS LOMAS RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2633
Mailing Address - Country:US
Mailing Address - Phone:505-924-2651
Mailing Address - Fax:505-924-2684
Practice Address - Street 1:904 LAS LOMAS RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2633
Practice Address - Country:US
Practice Address - Phone:505-924-2651
Practice Address - Fax:505-924-2684
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201898363LC0200X
FLAPRN9319861363LC0200X
NMCNP-01899363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003531Medicaid
NM12906727-EFF.3/26/13Medicaid
NC7003531Medicaid
NCQ27017Medicare UPIN