Provider Demographics
NPI:1124633938
Name:TIGANI, TAMARA MARINA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARINA
Last Name:TIGANI
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 1:2020 NORTHCLIFFE DR APT 718
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3378
Mailing Address - Country:US
Mailing Address - Phone:828-403-3133
Mailing Address - Fax:
Practice Address - Street 1:2020 NORTHCLIFFE DR APT 718
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3378
Practice Address - Country:US
Practice Address - Phone:828-403-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician