Individual
TANISHA KERIEL TART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
120 COASTAL HORIZONS DR, SHALLOTTE, NC 28470-6094
(910) 754-4515
Mailing address
615 SHIPYARD BLVD, WILMINGTON, NC 28412-6431
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5019957
NC
363LF0000X
Family Nurse Practitioner
5019957
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
27936
SC
Other
Enumeration date
03/25/2024
Last updated
04/30/2024
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