Provider Demographics
NPI:1225737042
Name:BAGNASCO, TAWNYA (LMT)
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:
Last Name:BAGNASCO
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 1:3261 US HWY 441
Mailing Address - Street 2:SUITE D-2
Mailing Address - City:FRUITLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:34731
Mailing Address - Country:US
Mailing Address - Phone:352-314-6599
Mailing Address - Fax:
Practice Address - Street 1:3261 US HWY 441
Practice Address - Street 2:SUITE D-2
Practice Address - City:FRUITLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:34731
Practice Address - Country:US
Practice Address - Phone:352-314-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89586225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist