Healthcare Provider Details

I. General information

NPI: 1669300976
Provider Name (Legal Business Name): ANTHONY LAMONT TATE CNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 W LENOX AVE
SPRINGFIELD IL
62704-4538
US

IV. Provider business mailing address

822 W LENOX AVE
SPRINGFIELD IL
62704-4538
US

V. Phone/Fax

Practice location:
  • Phone: 217-381-9507
  • Fax:
Mailing address:
  • Phone: 217-381-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: