Provider Demographics
NPI:1104565480
Name:BANIS, TMBUR (CNA)
Entity type:Individual
Prefix:
First Name:TMBUR
Middle Name:
Last Name:BANIS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-5928
Mailing Address - Country:US
Mailing Address - Phone:561-755-2991
Mailing Address - Fax:
Practice Address - Street 1:4019 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-5928
Practice Address - Country:US
Practice Address - Phone:561-755-2991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-03
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL406126376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7867879196Medicaid