Healthcare Provider Details

I. General information

NPI: 1962989491
Provider Name (Legal Business Name): TANYA ELIZABETH BOATWRIGHT ARNP FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 MALL RING RD
SEBRING FL
33870-8515
US

IV. Provider business mailing address

1298 RE BYRD RD
FROSTPROOF FL
33843-4618
US

V. Phone/Fax

Practice location:
  • Phone: 863-382-2229
  • Fax:
Mailing address:
  • Phone: 863-991-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberARNP9294873
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9294873
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberARNP9294873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: