Provider Demographics
NPI:1548856073
Name:VOGT, TANYA CHRISTINA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:CHRISTINA
Last Name:VOGT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51769 WESTPORT CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8222
Mailing Address - Country:US
Mailing Address - Phone:509-393-0792
Mailing Address - Fax:
Practice Address - Street 1:250 E. DAY ROAD
Practice Address - Street 2:SUITE 360
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545
Practice Address - Country:US
Practice Address - Phone:574-313-2933
Practice Address - Fax:574-313-8690
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003041A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant