Provider Demographics
NPI:1568067544
Name:CABALLERO, TATIANA (FNP)
Entity Type:Individual
Prefix:MS
First Name:TATIANA
Middle Name:
Last Name:CABALLERO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2659 CARAMBOLA CIR N APT 204
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2415
Mailing Address - Country:US
Mailing Address - Phone:561-536-8597
Mailing Address - Fax:
Practice Address - Street 1:2659 CARAMBOLA CIR N APT 204
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-2415
Practice Address - Country:US
Practice Address - Phone:561-536-8597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily