Healthcare Provider Details

I. General information

NPI: 1700151271
Provider Name (Legal Business Name): TANYA MARIE COOPER DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANYA TILLMAN/HATCH DNP, FNP-C

II. Dates (important events)

Enumeration Date: 03/17/2012
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2361 BISON RANCH TRL # 4
OVERGAARD AZ
85933-3277
US

IV. Provider business mailing address

PO BOX 1854
OVERGAARD AZ
85933-1854
US

V. Phone/Fax

Practice location:
  • Phone: 928-251-2611
  • Fax: 877-682-6177
Mailing address:
  • Phone: 928-251-2611
  • Fax: 877-682-6177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN127927
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP4528
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: