Provider Demographics
NPI:1023520004
Name:SMIT, TANYA JENNETTE (NP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:JENNETTE
Last Name:SMIT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 N 78TH ST
Mailing Address - Street 2:APT H106
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3709
Mailing Address - Country:US
Mailing Address - Phone:386-295-5065
Mailing Address - Fax:
Practice Address - Street 1:4201 TORRANCE BLVD STE 720
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4506
Practice Address - Country:US
Practice Address - Phone:310-571-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-30
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007705363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily