Healthcare Provider Details

I. General information

NPI: 1972085876
Provider Name (Legal Business Name): TANYA FELICIA ADAMS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 PALOMA HTS APT 101
COLORADO SPRINGS CO
80921-3247
US

IV. Provider business mailing address

2657 MYRA ST
JACKSONVILLE FL
32204-3517
US

V. Phone/Fax

Practice location:
  • Phone: 904-377-3769
  • Fax:
Mailing address:
  • Phone: 904-377-3769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1001749
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: