Provider Demographics
NPI:1225345820
Name:CABALLERO JIMENEZ, TANIA ISABEL (BCSN,MSN, ACNP- BC)
Entity Type:Individual
Prefix:MS
First Name:TANIA
Middle Name:ISABEL
Last Name:CABALLERO JIMENEZ
Suffix:
Gender:F
Credentials:BCSN,MSN, ACNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 MONROE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3043
Mailing Address - Country:US
Mailing Address - Phone:313-562-4100
Mailing Address - Fax:313-562-4590
Practice Address - Street 1:2421 MONROE ST STE 201
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3043
Practice Address - Country:US
Practice Address - Phone:313-562-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-03
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704247441363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care