Healthcare Provider Details

I. General information

NPI: 1568427094
Provider Name (Legal Business Name): TANGELA FUQUA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14509 CAPITAL DRIVE
PLAINFIELD IL
60544-4415
US

IV. Provider business mailing address

14509 CAPITAL DR
PLAINFIELD IL
60544-4415
US

V. Phone/Fax

Practice location:
  • Phone: 815-690-5946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041291415
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR190737
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28182264A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024174710
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: