Individual provider Active NPI

Tanya M Ignacio, CNM

  • Obstetrics & Gynecology Nurse Practitioner
  • Fairbanks, AK
National Provider Identifier
1649501594
Registry record updated Aug 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
1128 Issued in AK
Practice address
1626 30TH Ave
Fairbanks, AK 99701-7423
Phone
(907) 479-7701
Fax
(907) 479-7718
NPI assigned
Jan 15, 2010
Last updated
Aug 7, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 1128 AK Primary
Registered Nurse 163W00000X 30948 AK

Addresses

Primary practice location

1626 30TH Ave
Fairbanks, AK 99701-7423

Mailing address

1626 30TH Ave
Fairbanks, AK 99701-7423
Phone (907) 479-7701

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100724000320 AK Practitioner - Certified Nurse Midwife (CNM) 6608902937 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
30948AKMDRegistered Nurse
1128AKMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Interior Women's Health, LLC CurrentSince Mar 21, 2010 Accepting new patients
Fairbanks Memorial Hospital, LLC Past Accepting new patients

Locations

1626 30th Ave
Fairbanks, AK 99701
Phone (907) 479-0332

Interoperability endpoints

  • Direct secure messaging: tanya.ignacio.1@15989.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1263513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375833600000",
    "number": "1649501594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1626 30TH AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997017423",
            "telephone_number": "907-479-7701",
            "fax_number": "907-479-7718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1626 30TH AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997017423",
            "telephone_number": "907-479-7701",
            "fax_number": "907-479-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IGNACIO",
        "first_name": "TANYA",
        "middle_name": "M",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-15",
        "last_updated": "2013-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "AK",
            "license": "1128",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AK",
            "license": "30948",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

Verify at the official NPI Registry.