Provider Demographics
NPI:1811393499
Name:TAFURI, NICK
Entity Type:Individual
Prefix:
First Name:NICK
Middle Name:
Last Name:TAFURI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 SW GREENVILLE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32331-3113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:823 SW GREENVILLE HILLS ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:FL
Practice Address - Zip Code:32309
Practice Address - Country:US
Practice Address - Phone:850-948-1226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2927101Y00000X
101YM0800X
FLSW135921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health