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NPI Code Detail

MEDICARE: MIRLANDE TANIS

MEDICARE: MIRLANDE TANIS
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
1171M00000XCase Manager/Care Coordinator
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1225574403
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRLANDE TANIS
Provider Business Mailing Address
First Line : 1815 FOREST HILL BVLD
Second Line :
City : LAKE CLARKE SHORES
State : FL
Zip : 33406
Country : US
Telephone Number : 561-360-3168
Fax Number :
Provider Business Practice Location Address
First Line : 278 MILL RD
Second Line :
City : CHELMSFORD
State : MA
Zip : 01824-4106
Country : US
Telephone Number : 888-922-2843
Fax Number : 855-568-2494
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2017
Last Update Date : 07/11/2023

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Directions to “ MIRLANDE TANIS ” Practice Location

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