Provider Demographics
NPI:1184931925
Name:TANIFOR, JOSEPH NGWA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NGWA
Last Name:TANIFOR
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22620 OCEAN AVE APT 18
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3643
Mailing Address - Country:US
Mailing Address - Phone:323-839-7302
Mailing Address - Fax:
Practice Address - Street 1:11712 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-2324
Practice Address - Country:US
Practice Address - Phone:310-679-9293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP19411363LG0600X
CACNS3298364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology