Provider Demographics
NPI:1437497369
Name:TIVIN, ANNET (RN)
Entity Type:Individual
Prefix:MS
First Name:ANNET
Middle Name:
Last Name:TIVIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 PINEWALK DRIVE NORTH
Mailing Address - Street 2:APT 105
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063
Mailing Address - Country:US
Mailing Address - Phone:954-775-0789
Mailing Address - Fax:
Practice Address - Street 1:3425 PINEWALK DR N
Practice Address - Street 2:APT 105
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-7814
Practice Address - Country:US
Practice Address - Phone:954-775-0789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1906032163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care