Provider Demographics
NPI:1184664682
Name:TIENHAARA, NANCY NANETTE (MS, ATC L, EMT)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:NANETTE
Last Name:TIENHAARA
Suffix:
Gender:F
Credentials:MS, ATC L, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 NW 33RD PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7123
Mailing Address - Country:US
Mailing Address - Phone:954-747-8680
Mailing Address - Fax:
Practice Address - Street 1:4850 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7268
Practice Address - Country:US
Practice Address - Phone:954-731-7440
Practice Address - Fax:954-731-7675
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL1661174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist