Healthcare Provider Details

I. General information

NPI: 1285884965
Provider Name (Legal Business Name): TANYA F SMITH CRNA, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2008
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

2700 NEILSON WAY APT 221
SANTA MONICA CA
90405-4012
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7890
  • Fax:
Mailing address:
  • Phone: 504-416-0717
  • Fax: 504-977-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP05549
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: