Provider Demographics
NPI:1932950300
Name:TABORA, ANA CAROLINA
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:CAROLINA
Last Name:TABORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17400 THOMPSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49683-9231
Mailing Address - Country:US
Mailing Address - Phone:231-383-3360
Mailing Address - Fax:
Practice Address - Street 1:17400 THOMPSONVILLE RD
Practice Address - Street 2:
Practice Address - City:THOMPSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49683-9231
Practice Address - Country:US
Practice Address - Phone:231-383-3360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker