Provider Demographics
NPI:1356194708
Name:HOLMES, TANISE (SPECIALIST)
Entity type:Individual
Prefix:
First Name:TANISE
Middle Name:
Last Name:HOLMES
Suffix:
Gender:F
Credentials:SPECIALIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18350 NW 2ND AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4566
Mailing Address - Country:US
Mailing Address - Phone:786-483-5692
Mailing Address - Fax:
Practice Address - Street 1:18350 NW 2ND AVE STE 208
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33169-4566
Practice Address - Country:US
Practice Address - Phone:786-483-5692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management