Healthcare Provider Details

I. General information

NPI: 1407113657
Provider Name (Legal Business Name): HILAH TANEV PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 CLEVELAND CLINIC BLVD
WESTON FL
33331-3609
US

IV. Provider business mailing address

995 NE 170TH ST APT 205
NORTH MIAMI BEACH FL
33162-2558
US

V. Phone/Fax

Practice location:
  • Phone: 954-659-5000
  • Fax:
Mailing address:
  • Phone: 214-636-3427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number015546-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: