Provider Demographics
NPI:1700151271
Name:COOPER, TANYA MARIE (DNP, FNP-C)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:MARIE
Last Name:COOPER
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:TANYA
Other - Middle Name:
Other - Last Name:TILLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:PO BOX 2317
Mailing Address - Street 2:
Mailing Address - City:OVERGAARD
Mailing Address - State:AZ
Mailing Address - Zip Code:85933-2317
Mailing Address - Country:US
Mailing Address - Phone:928-892-5243
Mailing Address - Fax:928-297-3010
Practice Address - Street 1:2931 ARIZONA 260
Practice Address - Street 2:
Practice Address - City:HEBER-OVERGAARD
Practice Address - State:AZ
Practice Address - Zip Code:85933
Practice Address - Country:US
Practice Address - Phone:928-892-5243
Practice Address - Fax:928-297-3010
Is Sole Proprietor?:No
Enumeration Date:2012-03-17
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4528363LF0000X
AZRN127927163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse