Provider Demographics
NPI:1528947538
Name:GONCALVES, TATIANA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:MARIE
Last Name:GONCALVES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10305 NW 58TH ST STE 501
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4981
Mailing Address - Country:US
Mailing Address - Phone:786-953-7651
Mailing Address - Fax:
Practice Address - Street 1:10305 NW 58TH ST STE 501
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4981
Practice Address - Country:US
Practice Address - Phone:786-953-7651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11039389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily