Provider Demographics
NPI:1346873700
Name:TAVAREZ, NAZLI
Entity Type:Individual
Prefix:
First Name:NAZLI
Middle Name:
Last Name:TAVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 MEREDITH WAY
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-1179
Mailing Address - Country:US
Mailing Address - Phone:757-338-8368
Mailing Address - Fax:
Practice Address - Street 1:88 MEREDITH WAY
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1179
Practice Address - Country:US
Practice Address - Phone:757-338-8368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011475101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health