MEDICARE: TANYA SHREVE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9100202	FL
2	363A00000X	Physician Assistant	PA2005-0021	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558442400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA SHREVE PA

Provider Business Mailing Address
First Line	:	6911 PISTOL RANGE RD STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-6335
Country	:	US
Telephone Number	:	813-888-9924
Fax Number	:

Provider Business Practice Location Address
First Line	:	6911 PISTOL RANGE RD STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33635-6335
Country	:	US
Telephone Number	:	813-888-9924
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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Directions to “ TANYA SHREVE PA” Practice Location

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