Provider Demographics
NPI:1912673849
Name:TANNI, NUSRAT UDDIN (MD)
Entity Type:Individual
Prefix:
First Name:NUSRAT UDDIN
Middle Name:
Last Name:TANNI
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 1:12921 NW 2ND STREET
Mailing Address - Street 2:APT-308
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028
Mailing Address - Country:US
Mailing Address - Phone:469-558-7944
Mailing Address - Fax:
Practice Address - Street 1:703 N FLAMINGO ROAD,
Practice Address - Street 2:GME BUILDING, 2ND FLOOR,
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028
Practice Address - Country:US
Practice Address - Phone:469-558-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program