=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780980615
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA JEAN PIKE ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2011
-----------------------------------------------------
Last Update Date | 09/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 SUN TEMPLE DR.
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-774-5524
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 SUN TEMPLE DR
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-5924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-774-5524
-----------------------------------------------------
Fax | 256-774-5523
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | CRNP1-194303
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------