Provider Demographics
NPI:1891336327
Name:ANDERSON, TONY BERNARD SR (N/A)
Entity Type:Individual
Prefix:MR
First Name:TONY
Middle Name:BERNARD
Last Name:ANDERSON
Suffix:SR
Gender:M
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20324 NW 36TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-1749
Mailing Address - Country:US
Mailing Address - Phone:786-426-6250
Mailing Address - Fax:
Practice Address - Street 1:20324 NW 36TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-1749
Practice Address - Country:US
Practice Address - Phone:786-426-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic