Healthcare Provider Details

I. General information

NPI: 1760784631
Provider Name (Legal Business Name): CAROLYN JEAN TANKERSLEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLYN JEAN TANKERSLEY N.P.

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18849 KINGS HWY
MONTROSS VA
22520-2965
US

IV. Provider business mailing address

P.O. BOX 845347
DALLAS TX
75284-5347
US

V. Phone/Fax

Practice location:
  • Phone: 804-493-9999
  • Fax:
Mailing address:
  • Phone: 214-648-3916
  • Fax: 214-648-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP119530
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number596794
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: