Provider Demographics
NPI:1063872174
Name:GIVENS, TAJUANA
Entity type:Individual
Prefix:
First Name:TAJUANA
Middle Name:
Last Name:GIVENS
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 1:3600 S STATE ROAD 7 STE 320
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5290
Mailing Address - Country:US
Mailing Address - Phone:786-333-7922
Mailing Address - Fax:305-402-2861
Practice Address - Street 1:3600 S STATE ROAD 7 STE 320
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5290
Practice Address - Country:US
Practice Address - Phone:786-333-7922
Practice Address - Fax:305-402-2861
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101458000Medicaid
FL015341800Medicaid
FL101458000Medicaid