Provider Demographics
NPI:1093327009
Name:MABIEN, TONI
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:
Last Name:MABIEN
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 1:8761 N 56TH ST UNIT 292716
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-6274
Mailing Address - Country:US
Mailing Address - Phone:813-679-9119
Mailing Address - Fax:
Practice Address - Street 1:4701 E HANNA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-2522
Practice Address - Country:US
Practice Address - Phone:813-699-0955
Practice Address - Fax:813-803-8474
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver