Individual
TANYA RENEE HODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-BC
Contact information
Practice address
12385 SORRENTO RD STE D4, PENSACOLA, FL 32507-8656
(850) 495-9467
(850) 492-6347
Mailing address
PO BOX 3779, PENSACOLA, FL 32516-3779
(850) 516-0486
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
2631892
FL
363LA2200X
Adult Health Nurse Practitioner
Primary
2631892
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015171000
—
FL
01
—
Y7819
BLUE CROSS - FL
FL
Enumeration date
02/12/2007
Last updated
12/08/2021
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