=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407636707
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NADINE TANIS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2023
-----------------------------------------------------
Last Update Date | 10/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 445 NW 135TH ST
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33168-3844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-468-6169
-----------------------------------------------------
Fax | 786-953-6577
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12864 BISCAYNE BLVD # 318
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-468-6169
-----------------------------------------------------
Fax | 786-953-6577
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374J00000X
-----------------------------------------------------
Taxonomy Name | Doula
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------