Provider Demographics
NPI:1952052607
Name:CORREDERA SARMIENTO, TANIA
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:CORREDERA SARMIENTO
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 1:858 LINDA RD APT 4
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-4658
Mailing Address - Country:US
Mailing Address - Phone:561-452-3546
Mailing Address - Fax:
Practice Address - Street 1:858 LINDA RD APT 4
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4658
Practice Address - Country:US
Practice Address - Phone:561-452-3546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-190080106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty