Provider Demographics
NPI:1144821885
Name:BAILEY, TANYA LEE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:LEE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 VINING HILL RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9413
Mailing Address - Country:US
Mailing Address - Phone:413-896-3118
Mailing Address - Fax:
Practice Address - Street 1:185 VINING HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9413
Practice Address - Country:US
Practice Address - Phone:413-896-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN218393363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily