Provider Demographics
NPI:1316384712
Name:TANO, ANDRES CARLOS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:CARLOS
Last Name:TANO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1150 CAMPO SANO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1174
Mailing Address - Country:US
Mailing Address - Phone:786-268-6200
Mailing Address - Fax:786-533-9978
Practice Address - Street 1:1150 CAMPO SANO AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1174
Practice Address - Country:US
Practice Address - Phone:786-268-6200
Practice Address - Fax:786-533-9978
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant