MEDICARE: DR. TANYA VERONICA MARIN DNP, APRN, CPNP-PC/A

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	363LP0200X	Pediatric Nurse Practitioner	CNP-02627	NM
2	363L00000X	Nurse Practitioner	644173	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	644173	OTHER	TX	NURSE PRACTITIONERS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699799684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TANYA VERONICA MARIN DNP, APRN, CPNP-PC/A

Provider Business Mailing Address
First Line	:	6241 SNOWHEIGHTS CT
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-3801
Country	:	US
Telephone Number	:	915-740-4344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 COUNTRY CLUB RD
Second Line	:	SUITE 200
City	:	SANTA TERESA
State	:	NM
Zip	:	88008-9743
Country	:	US
Telephone Number	:	575-332-4633
Fax Number	:	575-332-4635

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	05/22/2019

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