Provider Demographics
NPI:1821366766
Name:FAJO, TANIA
Entity Type:Individual
Prefix:MRS
First Name:TANIA
Middle Name:
Last Name:FAJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 NW 136TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1932
Mailing Address - Country:US
Mailing Address - Phone:786-319-0456
Mailing Address - Fax:305-221-8501
Practice Address - Street 1:41 NW 136TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-1932
Practice Address - Country:US
Practice Address - Phone:786-319-0456
Practice Address - Fax:305-221-8501
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCNA 68343372500000X, 376K00000X
372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No372500000XNursing Service Related ProvidersChore Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide