Provider Demographics
NPI:1851016018
Name:BOTELLO, TANIA (RBT)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:BOTELLO
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7814 SAPPHIRE LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-8316
Mailing Address - Country:US
Mailing Address - Phone:407-271-2123
Mailing Address - Fax:
Practice Address - Street 1:7814 SAPPHIRE LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8316
Practice Address - Country:US
Practice Address - Phone:407-271-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL115534300Medicaid