Healthcare Provider Details

I. General information

NPI: 1902691140
Provider Name (Legal Business Name): TANIQUE SHAYAN HOWARD-BOONE DNP, NNP-BC, RNC-NIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SKYLARK CT
TIFTON GA
31793-8366
US

IV. Provider business mailing address

3 SKYLARK CT
TIFTON GA
31793-8366
US

V. Phone/Fax

Practice location:
  • Phone: 229-457-0691
  • Fax:
Mailing address:
  • Phone: 229-457-0691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberNP295718
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN295718
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: