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General NPI Number Information
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NPI Number | 1003689258
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Entity Type | Individual
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Provider Name | TINA-MARIE A LIBURD NAIL TECHNICIAN
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Gender | Female
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 23138 RAINBOW RD
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City | BOCA RATON
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State | FL
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Zip | 33428-5620
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Country | US
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Telephone | 954-696-4418
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8155
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City | CORAL SPRINGS
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State | FL
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Zip | 33075-8155
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Country | US
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Telephone | 954-696-4418
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374700000X
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Taxonomy Name | Technician
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License Number | FV9640664
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License Number State | FL
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