Healthcare Provider Details

I. General information

NPI: 1366131799
Provider Name (Legal Business Name): TANIA OLIVEIRA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8446 S HARRISON ST
MIDVALE UT
84047-3501
US

IV. Provider business mailing address

1298 N 1400 W
PROVO UT
84604-6039
US

V. Phone/Fax

Practice location:
  • Phone: 801-417-0131
  • Fax:
Mailing address:
  • Phone: 801-850-2397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number5244502-3102
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14006228-4405
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14006228-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: