Provider Demographics
NPI:1013547280
Name:TAITI, ANDIN RENATA
Entity Type:Individual
Prefix:MISS
First Name:ANDIN
Middle Name:RENATA
Last Name:TAITI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 MARSHALL DR S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-8531
Mailing Address - Country:US
Mailing Address - Phone:312-852-6862
Mailing Address - Fax:
Practice Address - Street 1:344 MARSHALL DR S
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-8531
Practice Address - Country:US
Practice Address - Phone:312-852-6862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337475164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty