MEDICARE: TANISE L BETHEL-GUERRA RN

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	376J00000X	Homemaker	239065	FL
2	376K00000X	Nurse's Aide	239065	FL
3	372600000X	Adult Companion	239065	FL

General Provider Information

NPI Number	:	1841977162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANISE L BETHEL-GUERRA RN

Provider Business Mailing Address
First Line	:	10700 CARIBBEAN BLVD STE 301
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-1230
Country	:	US
Telephone Number	:	786-876-1622
Fax Number	:

Provider Business Practice Location Address
First Line	:	10700 CARIBBEAN BLVD STE 301
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-1230
Country	:	US
Telephone Number	:	786-876-1622
Fax Number	:

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

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	06/28/2023

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