Individual
TANYA SANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
738 S GLOSTER ST STE B, TUPELO, MS 38801-4932
(662) 630-4005
Mailing address
738 S GLOSTER ST STE B, TUPELO, MS 38801-4932
(662) 630-4005
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
903201
MS
Other
Enumeration date
08/16/2019
Last updated
10/13/2023
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