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General NPI Number Information
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NPI Number | 1316676620
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Entity Type | Individual
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Provider Name | TAFIA CORA GREEN
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Gender | Female
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 06/10/2022
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Provider Practice Location Address
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Address Line | 4800 NW 20TH CT
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City | LAUDERHILL
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State | FL
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Zip | 33313-4145
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Country | US
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Telephone | 954-732-7761
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Fax |
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Provider Business Mailing Address
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Address Line | 4510 NW 24TH ST
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City | LAUDERHILL
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State | FL
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Zip | 33313-3527
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Country | US
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Telephone | 954-732-7761
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11012619
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License Number State | FL
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