Provider Demographics
NPI:1346538238
Name:JAMIS, TATIANA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:TATIANA
Middle Name:
Last Name:JAMIS
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 1:13070 SW 88TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1606
Mailing Address - Country:US
Mailing Address - Phone:786-709-6160
Mailing Address - Fax:305-444-9550
Practice Address - Street 1:701 NW 57TH AVE
Practice Address - Street 2:# 200
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3275
Practice Address - Country:US
Practice Address - Phone:305-444-1555
Practice Address - Fax:305-444-9550
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 47879225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA47879OtherMASSAGE LICENSE