Provider Demographics
NPI:1154603132
Name:HARTJE-AIKEN, TANJA
Entity type:Individual
Prefix:MRS
First Name:TANJA
Middle Name:
Last Name:HARTJE-AIKEN
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 1:13555 JAEGER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33953-1338
Mailing Address - Country:US
Mailing Address - Phone:941-585-1171
Mailing Address - Fax:
Practice Address - Street 1:12200 SAN SERVANDO AVE
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-1229
Practice Address - Country:US
Practice Address - Phone:941-426-1692
Practice Address - Fax:941-429-9183
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51066225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist