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:GULF COAST MENTAL HEALTH CENTER
Mailing Address - Street 2:1600 BROAD AVE
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-3009
Mailing Address - Country:US
Mailing Address - Phone:228-863-1132
Mailing Address - Fax:
Practice Address - Street 1:GULF COAST MENTAL HEALTH CENTER
Practice Address - Street 2:1600 BROAD AVE
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501
Practice Address - Country:US
Practice Address - Phone:228-863-1132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-25
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily