Provider Demographics
NPI:1568723229
Name:TANIFORM, TERENCE (HHA)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:TANIFORM
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8722 RITCHBORO RD
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-2630
Mailing Address - Country:US
Mailing Address - Phone:301-437-4545
Mailing Address - Fax:
Practice Address - Street 1:8722 RITCHBORO RD
Practice Address - Street 2:
Practice Address - City:DISTRICT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20747-2630
Practice Address - Country:US
Practice Address - Phone:301-437-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide