Provider Demographics
NPI:1881024214
Name:BANKSTON, TIAJUANA (NURSING ASSISTANCE)
Entity Type:Individual
Prefix:
First Name:TIAJUANA
Middle Name:
Last Name:BANKSTON
Suffix:
Gender:F
Credentials:NURSING ASSISTANCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 RAMONA ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2534
Mailing Address - Country:US
Mailing Address - Phone:786-565-2414
Mailing Address - Fax:
Practice Address - Street 1:7601 RAMONA ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2534
Practice Address - Country:US
Practice Address - Phone:786-565-2414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-21
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231312171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor