Healthcare Provider Details

I. General information

NPI: 1962122275
Provider Name (Legal Business Name): TANYA NICOLE ESMONT DNP, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31581 GRATIOT AVE
ROSEVILLE MI
48066-4528
US

IV. Provider business mailing address

31581 GRATIOT AVE
ROSEVILLE MI
48066-4528
US

V. Phone/Fax

Practice location:
  • Phone: 586-783-4802
  • Fax:
Mailing address:
  • Phone: 586-557-7137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704307550
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: