Healthcare Provider Details

I. General information

NPI: 1265369128
Provider Name (Legal Business Name): TDN HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

11389 SW 65TH ST
MIAMI FL
33173-1974
US

IV. Provider business mailing address

11389 SW 65TH ST
MIAMI FL
33173-1974
US

V. Phone/Fax

Practice location:
  • Phone: 484-538-0690
  • Fax:
Mailing address:
  • Phone: 484-538-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VICTOR MANUEL TATIS DE LA NUEZ
Title or Position: MANAGING MEMBER
Credential: APRN
Phone: 484-538-0690