Individual
TANYA WILSON TULLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
1001 HOLLAND AVE, PHILADELPHIA, MS 39350-2161
(601) 781-2234
(601) 781-2231
Mailing address
1001 HOLLAND AVE, PHILADELPHIA, MS 39350-2161
(601) 781-2234
(601) 781-2231
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
904858
MS
Other
Enumeration date
09/26/2019
Last updated
09/08/2021
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