Provider Demographics
NPI:1356950596
Name:TERRELL, TANYA (CNA)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:TERRELL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 GREENWAY BLVD APT D
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-6435
Mailing Address - Country:US
Mailing Address - Phone:305-834-6080
Mailing Address - Fax:
Practice Address - Street 1:7921 GREENWAY BLVD APT D
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-6435
Practice Address - Country:US
Practice Address - Phone:305-834-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL370532376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide