MEDICARE: TANYA A THOMAS NP

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	363LF0000X	Family Nurse Practitioner	RN177598	GA
2	363L00000X	Nurse Practitioner	AP141168	TX

General Provider Information

NPI Number	:	1770964934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA A THOMAS NP

Provider Business Mailing Address
First Line	:	78 SOUTHERN GOLF CT
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-8008
Country	:	US
Telephone Number	:	678-472-4386
Fax Number	:

Provider Business Practice Location Address
First Line	:	78 SOUTHERN GOLF CT
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-8008
Country	:	US
Telephone Number	:	678-472-4386
Fax Number	:

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

Provider Enumeration Date	:	06/13/2015
Last Update Date	:	03/06/2026

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Directions to “ TANYA A THOMAS NP” Practice Location

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