Basic Information
Provider Information
NPI: 1033558135
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DUNN
FirstName: TANIKA
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8001 SW 36TH ST
Address2: SUITE 9
City: DAVIE
State: FL
PostalCode: 333281915
CountryCode: US
TelephoneNumber: 9545777790
FaxNumber: 9545777780
Practice Location
Address1: 8001 SW 36TH ST
Address2: SUITE 9
City: DAVIE
State: FL
PostalCode: 333281915
CountryCode: US
TelephoneNumber: 9545777790
FaxNumber: 9545777780
Other Information
ProviderEnumerationDate: 06/21/2013
LastUpdateDate: 06/21/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


Home