Provider Demographics
NPI:1962284240
Name:SMITH, TANYA SIMPKINS (AGNP)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:SIMPKINS
Last Name:SMITH
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 PASSOUR RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-0178
Mailing Address - Country:US
Mailing Address - Phone:704-840-7616
Mailing Address - Fax:
Practice Address - Street 1:1380 EASTCHESTER DR STE 105
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2659
Practice Address - Country:US
Practice Address - Phone:336-521-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019290363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health