Healthcare Provider Details

I. General information

NPI: 1356950596
Provider Name (Legal Business Name): TANYA TERRELL CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7921 GREENWAY BLVD APT D
MIRAMAR FL
33023-6435
US

IV. Provider business mailing address

7921 GREENWAY BLVD APT D
MIRAMAR FL
33023-6435
US

V. Phone/Fax

Practice location:
  • Phone: 305-834-6080
  • Fax:
Mailing address:
  • Phone: 305-834-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number370532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: