=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598239162
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANYA MARIE SPIEGEL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2019
-----------------------------------------------------
Last Update Date | 01/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16311 SW 88TH PL
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-3580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-801-7624
-----------------------------------------------------
Fax | 305-971-9455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16311 SW 88TH PL
-----------------------------------------------------
City | PALMETTO BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-3580
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-801-7624
-----------------------------------------------------
Fax | 305-971-9455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------