Provider Demographics
NPI:1518130947
Name:MONTALVO, TANIA DELGADO (PA-C)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:DELGADO
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:D
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:201 NW 82ND AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1854
Mailing Address - Country:US
Mailing Address - Phone:954-475-9535
Mailing Address - Fax:
Practice Address - Street 1:201 NW 82ND AVE STE 205
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1854
Practice Address - Country:US
Practice Address - Phone:954-475-9535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104327363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK638ZMedicare PIN