Provider Demographics
NPI:1174043483
Name:GRAHAM, TIANA L
Entity Type:Individual
Prefix:MS
First Name:TIANA
Middle Name:L
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PHLEBEX
Other - Middle Name:
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHLEBOTOMIST
Mailing Address - Street 1:2415 LINCOLN ST APT 101
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-3948
Mailing Address - Country:US
Mailing Address - Phone:203-343-0503
Mailing Address - Fax:
Practice Address - Street 1:2415 LINCOLN ST. # 101
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020
Practice Address - Country:US
Practice Address - Phone:203-343-0503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy