Healthcare Provider Details

I. General information

NPI: 1649872250
Provider Name (Legal Business Name): TURENA RAPHIEL TANTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 NORTH AVE
COLUMBUS GA
31901-1525
US

IV. Provider business mailing address

6419 OLD POST CT
COLUMBUS GA
31909-3405
US

V. Phone/Fax

Practice location:
  • Phone: 706-596-1245
  • Fax:
Mailing address:
  • Phone: 706-593-1221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN139191
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: