MEDICARE: MRS. NANCY NANETTE TIENHAARA M.S, ATC L, EMT

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	AL1661	FL

General Provider Information

NPI Number	:	1184664682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY NANETTE TIENHAARA M.S, ATC L, EMT

Provider Business Mailing Address
First Line	:	9340 NW 33RD PL
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33351-7123
Country	:	US
Telephone Number	:	954-747-8680
Fax Number	:

Provider Business Practice Location Address
First Line	:	4850 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-7268
Country	:	US
Telephone Number	:	954-731-7440
Fax Number	:	954-731-7675

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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