MEDICARE: MS. TATIANA PASSE

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	9235770	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205126745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TATIANA PASSE

Provider Business Mailing Address
First Line	:	6301 NW 52ND ST
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33067-2150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33313-1913
Country	:	US
Telephone Number	:	954-733-7473
Fax Number	:

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

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	04/18/2011

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