Healthcare Provider Details

I. General information

NPI: 1841115375
Provider Name (Legal Business Name): AFIAVI TINA DE MEDEIROS CMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 N 148TH CT
OMAHA NE
68116-7212
US

IV. Provider business mailing address

11415 CORBY PLZ # 3206
OMAHA NE
68164-9664
US

V. Phone/Fax

Practice location:
  • Phone: 520-977-3083
  • Fax:
Mailing address:
  • Phone: 520-977-3083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: