Healthcare Provider Details

I. General information

NPI: 1316557044
Provider Name (Legal Business Name): TANYA BOATWRIGHT CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 WOODED CROSSING CIR
SAINT AUGUSTINE FL
32084-6548
US

IV. Provider business mailing address

PO BOX 754
SAINT AUGUSTINE FL
32085-0754
US

V. Phone/Fax

Practice location:
  • Phone: 904-844-1467
  • Fax:
Mailing address:
  • Phone: 904-844-1467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA133486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: