Healthcare Provider Details

I. General information

NPI: 1871091975
Provider Name (Legal Business Name): FLORENCIA TARASIDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2018
Last Update Date: 02/22/2022
Certification Date: 02/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 EVENING PINE LN
ALPHARETTA GA
30005-7417
US

IV. Provider business mailing address

660 EVENING PINE LN
ALPHARETTA GA
30005-7417
US

V. Phone/Fax

Practice location:
  • Phone: 770-380-2160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-122267
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: