Healthcare Provider Details

I. General information

NPI: 1053828756
Provider Name (Legal Business Name): TANYA TROTTER WINBUSH REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2018
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1168 ANDREWS CT
CREEDMOOR NC
27522-7274
US

IV. Provider business mailing address

1168 ANDREWS CT
CREEDMOOR NC
27522-7274
US

V. Phone/Fax

Practice location:
  • Phone: 919-283-1883
  • Fax:
Mailing address:
  • Phone: 919-283-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5025627
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: