MEDICARE: TANYA MARIE COOPER DNP, FNP-C

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	163W00000X	Registered Nurse	RN127927	AZ
2	363LF0000X	Family Nurse Practitioner	AP4528	AZ

General Provider Information

NPI Number	:	1700151271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA MARIE COOPER DNP, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 1854
Second Line	:
City	:	OVERGAARD
State	:	AZ
Zip	:	85933-1854
Country	:	US
Telephone Number	:	928-251-2611
Fax Number	:	877-682-6177

Provider Business Practice Location Address
First Line	:	2361 BISON RANCH TRL # 4
Second Line	:
City	:	OVERGAARD
State	:	AZ
Zip	:	85933-3277
Country	:	US
Telephone Number	:	928-251-2611
Fax Number	:	877-682-6177

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

Provider Enumeration Date	:	03/17/2012
Last Update Date	:	04/22/2026

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