Healthcare Provider Details

I. General information

NPI: 1689829020
Provider Name (Legal Business Name): COURTNY ELIZABETH TANIGAWA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: COURTNY ELIZABETH EAST APRN

II. Dates (important events)

Enumeration Date: 11/26/2008
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91-1010 SHANGRILLA STREET KALAELOA PROFESSIONAL CENTER
KAPOLEI HI
96707
US

IV. Provider business mailing address

1778 BERTRAM STREET
HONOLULU HI
96816
US

V. Phone/Fax

Practice location:
  • Phone: 808-381-2267
  • Fax: 808-677-2570
Mailing address:
  • Phone: 808-671-8511
  • Fax: 808-677-2570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN 735
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN 735
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: