Healthcare Provider Details

I. General information

NPI: 1073436820
Provider Name (Legal Business Name): TANASIA PEAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 HARBOUR POINTE DR
COLUMBIA SC
29229-7483
US

IV. Provider business mailing address

2715 COLONIAL DR
COLUMBIA SC
29203-6818
US

V. Phone/Fax

Practice location:
  • Phone: 347-893-1301
  • Fax:
Mailing address:
  • Phone: 803-935-5735
  • Fax: 803-935-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number288514
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: