Individual
TANYA J BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC
Contact information
Practice address
4801 VETERANS DR, ST CLOUD VAHCS, ST CLOUD, MN 56303
(320) 252-1670
Mailing address
4801 VETERANS DR, ST CLOUD VAHCS, ST CLOUD, MN 56303
(320) 252-1670
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2006005172
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71612000
—
MN
Enumeration date
09/20/2006
Last updated
01/26/2016
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