Most Relevant Information
Provider Data
| NPI Number: | 1003372293 |
| Provider Name: | TANISHA LEONARD AGACNP-BC |
| Entity Type: | Individual |
| Taxonomy Code: | 363LA2100X |
| Specialty: | Nurse Practitioner |
| License Number: | RN204055 |
Most Important Dates
| Enumeration Date: | 02/13/2019 |
| Last Updated: | 03/16/2022 |
Provider Practice Location
55 WHITCHER ST NE STE 350
MARIETTA
GA
300601129
Practice Location Phone/Fax
| Phone: | 7704246893 |
| Fax: | 7705289938 |
Provider Mailing Location
55 WHITCHER ST NE STE 350
MARIETTA
GA
300601129
Provider Mailing Phone/Fax
| Phone: | 7704246893 |
| Fax: | 7705289938 |