Provider Demographics
NPI:1447121264
Name:SMITH, TANIQUA CHANICE (RN)
Entity type:Individual
Prefix:MS
First Name:TANIQUA
Middle Name:CHANICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-412 KEALOHI PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-2644
Mailing Address - Country:US
Mailing Address - Phone:774-433-1350
Mailing Address - Fax:
Practice Address - Street 1:94-412 KEALOHI PL
Practice Address - Street 2:
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789-2644
Practice Address - Country:US
Practice Address - Phone:774-433-1350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILPN-21452164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse