Provider Demographics
NPI:1902294093
Name:BARNES, TANGULAR
Entity type:Individual
Prefix:
First Name:TANGULAR
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2715 BULLIS AVE
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-5233
Mailing Address - Country:US
Mailing Address - Phone:228-220-4226
Mailing Address - Fax:228-220-4303
Practice Address - Street 1:2715 BULLIS AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-5233
Practice Address - Country:US
Practice Address - Phone:228-220-4226
Practice Address - Fax:228-220-4303
Is Sole Proprietor?:No
Enumeration Date:2014-12-25
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866289363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily