Provider Demographics
NPI:1790380301
Name:DAWKINS, TANISHA DEL CARMEN (APRN)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:DEL CARMEN
Last Name:DAWKINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14601 SW 29TH ST STE 209
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4715
Mailing Address - Country:US
Mailing Address - Phone:954-436-8036
Mailing Address - Fax:954-217-4006
Practice Address - Street 1:14601 SW 29TH ST STE 209
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4715
Practice Address - Country:US
Practice Address - Phone:954-436-8036
Practice Address - Fax:954-217-4006
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010010363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA