Provider Demographics
NPI:1336870450
Name:TAVAREZ, LAURA YARINA (CNA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:YARINA
Last Name:TAVAREZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 BAYSHORE CT
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5025
Mailing Address - Country:US
Mailing Address - Phone:813-506-2759
Mailing Address - Fax:
Practice Address - Street 1:145 BAYSHORE CT
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5025
Practice Address - Country:US
Practice Address - Phone:813-506-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL328953374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty