Provider Demographics
NPI:1992460885
Name:LEE, TANYA RICHARDSON (FNP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:RICHARDSON
Last Name:LEE
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 1:600 RIDGELY AVE STE 231
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1092
Mailing Address - Country:US
Mailing Address - Phone:410-266-8116
Mailing Address - Fax:410-266-7820
Practice Address - Street 1:600 RIDGELY AVE STE 231
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1092
Practice Address - Country:US
Practice Address - Phone:410-266-8116
Practice Address - Fax:410-266-7820
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR133375363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily