Provider Demographics
NPI:1144252644
Name:ROWE NIX, TANYA D (CRNP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:D
Last Name:ROWE NIX
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 3RD AVE S
Mailing Address - Street 2:FOT 950
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-3409
Mailing Address - Country:US
Mailing Address - Phone:205-975-3892
Mailing Address - Fax:205-975-2319
Practice Address - Street 1:1530 3RD AVE S
Practice Address - Street 2:FOT 950
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-3409
Practice Address - Country:US
Practice Address - Phone:205-975-3892
Practice Address - Fax:205-975-2319
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-064183363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS79120Medicare UPIN