Healthcare Provider Details

I. General information

NPI: 1760006886
Provider Name (Legal Business Name): TANI REYNOLDS CALVERT AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. TANI REYNOLDS

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 S UTICA AVE FL 4
TULSA OK
74104-6520
US

IV. Provider business mailing address

1923 S UTICA AVE FL 4
TULSA OK
74104-6520
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-2868
  • Fax: 918-403-6348
Mailing address:
  • Phone: 918-744-2868
  • Fax: 918-403-6348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number94325
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR0094325
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: