Provider Demographics
NPI:1841977162
Name:BETHEL-GUERRA, TANISE L (RN)
Entity type:Individual
Prefix:
First Name:TANISE
Middle Name:L
Last Name:BETHEL-GUERRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 CARIBBEAN BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1230
Mailing Address - Country:US
Mailing Address - Phone:786-876-1622
Mailing Address - Fax:
Practice Address - Street 1:10700 CARIBBEAN BLVD STE 301
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1230
Practice Address - Country:US
Practice Address - Phone:786-876-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL239065376J00000X, 376K00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty