Provider Demographics
NPI:1003689258
Name:LIBURD, TINA-MARIE A (NAIL TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:TINA-MARIE
Middle Name:A
Last Name:LIBURD
Suffix:
Gender:F
Credentials:NAIL TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8155
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33075-8155
Mailing Address - Country:US
Mailing Address - Phone:954-696-4418
Mailing Address - Fax:
Practice Address - Street 1:23138 RAINBOW RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-5620
Practice Address - Country:US
Practice Address - Phone:954-696-4418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-31
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFV9640664374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty