MEDICARE: MS. DEBRA J TANTILLO

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	1041C0700X	Clinical Social Worker	SW5538	FL

General Provider Information

NPI Number	:	1376822981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA J TANTILLO

Provider Business Mailing Address
First Line	:	333 NW 46TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-4010
Country	:	US
Telephone Number	:	954-732-5418
Fax Number	:	954-772-1023

Provider Business Practice Location Address
First Line	:	3115 NW 10TH TER STE 103
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-5937
Country	:	US
Telephone Number	:	954-732-5418
Fax Number	:	954-772-1023

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

Provider Enumeration Date	:	08/12/2011
Last Update Date	:	03/20/2025

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