Healthcare Provider Details

I. General information

NPI: 1154251379
Provider Name (Legal Business Name): TANISHA INES ZEVALLOS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 E ALTAMONTE DR STE 318
ALTAMONTE SPRINGS FL
32701-5103
US

IV. Provider business mailing address

3067 LEFLORE LN
ORLANDO FL
32833-5530
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-5204
  • Fax:
Mailing address:
  • Phone: 646-394-1838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: