Provider Demographics
NPI:1679928808
Name:ROBERGE, TANYA (NP)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ROBERGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 MADISON ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4903
Mailing Address - Country:US
Mailing Address - Phone:931-802-6824
Mailing Address - Fax:931-802-6827
Practice Address - Street 1:1849 MADISON ST
Practice Address - Street 2:SUITE F
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4903
Practice Address - Country:US
Practice Address - Phone:931-802-6824
Practice Address - Fax:931-802-6827
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21028363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner