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General NPI Number Information
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NPI Number | 1760006886
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Entity Type | Individual
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Provider Name | TANI REYNOLDS CALVERT AGACNP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 1923 S UTICA AVE FL 4
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City | TULSA
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State | OK
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Zip | 74104-6520
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Country | US
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Telephone | 918-744-2868
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Fax | 918-403-6348
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Provider Business Mailing Address
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Address Line | 1923 S UTICA AVE FL 4
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City | TULSA
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State | OK
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Zip | 74104-6520
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Country | US
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Telephone | 918-744-2868
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Fax | 918-403-6348
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SG0600X
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Taxonomy Name | Gerontology Clinical Nurse Specialist
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License Number | 94325
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R0094325
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License Number State | OK
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