MEDICARE: TATIANA DAVALOS SARRIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11025515	FL

General Provider Information

NPI Number	:	1174228795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA DAVALOS SARRIA

Provider Business Mailing Address
First Line	:	15 PHOENETIA AVE APT 404
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-3470
Country	:	US
Telephone Number	:	305-205-8067
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 PHOENETIA AVE APT 404
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-3470
Country	:	US
Telephone Number	:	305-205-8067
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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