Provider Demographics
NPI:1710715545
Name:SHELTON, TANYA LYNN (CPNP-PC)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 OAK PARK DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-7302
Mailing Address - Country:US
Mailing Address - Phone:970-267-9510
Mailing Address - Fax:970-207-9967
Practice Address - Street 1:1214 OAK PARK DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-7302
Practice Address - Country:US
Practice Address - Phone:970-267-9510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0999988-NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics