Healthcare Provider Details

I. General information

NPI: 1336346840
Provider Name (Legal Business Name): TANYA REAMS SMALLWOOD ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE HEART CENTER ADMINISTRATION
RALEIGH NC
27610-1231
US

IV. Provider business mailing address

2707 SALISBURY PLN
RALEIGH NC
27613-4333
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-7601
  • Fax:
Mailing address:
  • Phone: 919-845-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number134133
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900302
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: