Healthcare Provider Details

I. General information

NPI: 1265656888
Provider Name (Legal Business Name): TANYA BARNES-REAVES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 NW 36TH ST
MIAMI FL
33142-5557
US

IV. Provider business mailing address

2822 NW 212TH ST
MIAMI GARDENS FL
33056-1131
US

V. Phone/Fax

Practice location:
  • Phone: 305-635-7444
  • Fax:
Mailing address:
  • Phone: 786-261-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 3049462
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: