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1922600279 NPI number — EVELYN LEMA TANKOH MRN, APRN, AGNP-BC

NPI Number: 1922600279
Health Care Provider/Practitioner: EVELYN LEMA TANKOH MRN, APRN, AGNP-BC

Information about “1922600279” NPI (EVELYN LEMA TANKOH MRN, APRN, AGNP-BC) exists in 1922600279 in HTML format HTML  |  1922600279 in plain Text format TXT  |  1922600279 in PDF (Portable Document Format) PDF  |  1922600279 in an XML format XML  formats.

NPI Number : 1922600279 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1922600279",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TANKOH",
    "FirstName": "EVELYN",
    "MiddleName": "LEMA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MRN, APRN, AGNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1975 HIGHWAY 54 W STE 205",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEACHTREE CITY",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30269-4794",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-585-2384",
    "MailingAddressFaxNumber": "470-288-0223",
    "FirstLinePracticeLocationAddress": "7130 MOUNT ZION BLVD STE 14B",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JONESBORO",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30236-2566",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "770-585-2384",
    "PracticeLocationAddressFaxNumber": "470-288-0223",
    "EnumerationDate": "11/11/2020",
    "LastUpdateDate": "09/19/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163WG0000X",
          "TaxonomyName": "General Practice Registered Nurse",
          "LicenseNumber": "RN118032",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WG0600X",
          "TaxonomyName": "Gerontology Registered Nurse",
          "LicenseNumber": "RN118032",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "LicenseNumber": "RN118032",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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