MEDICARE: TANYA N PRETE CCLS

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	174400000X	Specialist

General Provider Information

NPI Number	:	1174835011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA N PRETE CCLS

Provider Business Mailing Address
First Line	:	7323 BLACK WALNUT WAY
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-6401
Country	:	US
Telephone Number	:	941-284-4734
Fax Number	:

Provider Business Practice Location Address
First Line	:	7323 BLACK WALNUT WAY
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34202-6401
Country	:	US
Telephone Number	:	941-284-4734
Fax Number	:

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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