Provider Demographics
NPI:1043697949
Name:FARRIS-STEWARD, TANYA (LMT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:FARRIS-STEWARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6898 HOULTON CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8741
Mailing Address - Country:US
Mailing Address - Phone:561-870-0980
Mailing Address - Fax:
Practice Address - Street 1:6898 HOULTON CIR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-8741
Practice Address - Country:US
Practice Address - Phone:561-870-0980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55040174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist