MEDICARE: TANIA GRACIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	MH9768	FL
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730495623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANIA GRACIA

Provider Business Mailing Address
First Line	:	1039 HILLSBORO MILE APT 22
Second Line	:
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062-2105
Country	:	US
Telephone Number	:	954-882-6595
Fax Number	:

Provider Business Practice Location Address
First Line	:	1039 HILLSBORO MILE APT 22
Second Line	:
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062
Country	:	US
Telephone Number	:	954-882-6595
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	08/17/2018

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Directions to “ TANIA GRACIA ” Practice Location

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