Provider Demographics
NPI:1831718956
Name:HUSSAIN, TANIA (MD)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12136 COBBLE STONE DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-2432
Mailing Address - Country:US
Mailing Address - Phone:727-863-5474
Mailing Address - Fax:727-868-0312
Practice Address - Street 1:12136 COBBLE STONE DR
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-2432
Practice Address - Country:US
Practice Address - Phone:727-863-5474
Practice Address - Fax:727-868-0312
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL162042208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program