Provider Demographics
NPI:1801129903
Name:TAMIN, ELVIS NANA
Entity type:Individual
Prefix:MR
First Name:ELVIS
Middle Name:NANA
Last Name:TAMIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11991 AUDELIA RD APT 114
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-0440
Mailing Address - Country:US
Mailing Address - Phone:214-475-6693
Mailing Address - Fax:
Practice Address - Street 1:11991 AUDELIA RD APT 114
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-0440
Practice Address - Country:US
Practice Address - Phone:214-475-6693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200471164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse