Healthcare Provider Details

I. General information

NPI: 1699908582
Provider Name (Legal Business Name): TANIA ANN URENDA ASCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANIA ANN JOHNSON ASCP

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

439 GRAY HORSE CIR
WOODLAND PARK CO
80863-8943
US

IV. Provider business mailing address

439 GRAY HORSE CIR
WOODLAND PARK CO
80863-8943
US

V. Phone/Fax

Practice location:
  • Phone: 850-259-8642
  • Fax:
Mailing address:
  • Phone: 850-259-8642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberTN 38271
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: