Provider Demographics
NPI:1467020875
Name:GANO, TWANDA
Entity Type:Individual
Prefix:MS
First Name:TWANDA
Middle Name:
Last Name:GANO
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:PO BOX 3690
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-3690
Mailing Address - Country:US
Mailing Address - Phone:813-526-4213
Mailing Address - Fax:813-450-3642
Practice Address - Street 1:3712 PATINA DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-1252
Practice Address - Country:US
Practice Address - Phone:813-455-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities