Provider Demographics
NPI:1023485695
Name:TANN-STARR, CAROLYN
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:TANN-STARR
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 1:440 MERCER ST NW
Mailing Address - Street 2:TANNQIGONG INSTITUTE INC.
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2933
Mailing Address - Country:US
Mailing Address - Phone:321-614-5657
Mailing Address - Fax:321-473-8318
Practice Address - Street 1:230 E MONUMENT AVE STE A4
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5731
Practice Address - Country:US
Practice Address - Phone:321-614-5657
Practice Address - Fax:321-473-8318
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372600000X, 246ZI1000X, 374U00000X, 390200000X
FLCNA329819376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No246ZI1000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherIllustration, Medical
No374U00000XNursing Service Related ProvidersHome Health Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program