Healthcare Provider Details

I. General information

NPI: 1083270797
Provider Name (Legal Business Name): TANYA CYNTHIA NICOLE HARTE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 08/11/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 N BALLAS RD DIV ANES PAIN MGT
SAINT LOUIS MO
63131-2329
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7200
  • Fax: 314-996-7376
Mailing address:
  • Phone: 314-996-7200
  • Fax: 314-996-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2019009484
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: