Provider Demographics
NPI:1053742601
Name:MCCAULEY, TANYA DELENE (NP)
Entity type:Individual
Prefix:MRS
First Name:TANYA
Middle Name:DELENE
Last Name:MCCAULEY
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:26445 WESTMEATH ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-4753
Mailing Address - Country:US
Mailing Address - Phone:313-595-9710
Mailing Address - Fax:
Practice Address - Street 1:TEAM WELLNESS CENTER
Practice Address - Street 2:2925 RUSSELL ST
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-396-5300
Practice Address - Fax:313-587-1876
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2024-05-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704219165363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner