MEDICARE: MS. TWANDA GANO

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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1467020875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TWANDA GANO

Provider Business Mailing Address
First Line	:	PO BOX 3690
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33509-3690
Country	:	US
Telephone Number	:	813-526-4213
Fax Number	:	813-450-3642

Provider Business Practice Location Address
First Line	:	3712 PATINA DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-1252
Country	:	US
Telephone Number	:	813-455-5550
Fax Number	:

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

Provider Enumeration Date	:	06/12/2021
Last Update Date	:	06/12/2021

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Directions to “ MS. TWANDA GANO ” Practice Location

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