Healthcare Provider Details

I. General information

NPI: 1447763818
Provider Name (Legal Business Name): TANGY CHERIE SMALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 22ND AVE S
SAINT PETERSBURG FL
33705-2934
US

IV. Provider business mailing address

PO BOX 10970
SAINT PETERSBURG FL
33733-0970
US

V. Phone/Fax

Practice location:
  • Phone: 727-327-7656
  • Fax: 727-322-2110
Mailing address:
  • Phone: 727-327-7656
  • Fax: 727-322-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN9321893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: