Healthcare Provider Details

I. General information

NPI: 1780227751
Provider Name (Legal Business Name): DANIELLE MARIE TANQUE F.N.P.-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4334 ACUSHNET AVE
NEW BEDFORD MA
02745-4614
US

IV. Provider business mailing address

4334 ACUSHNET AVE
NEW BEDFORD MA
02745-4614
US

V. Phone/Fax

Practice location:
  • Phone: 774-438-4331
  • Fax: 800-314-8017
Mailing address:
  • Phone: 774-438-4331
  • Fax: 800-314-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2269821
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2269821
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberRN2269821
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: