Provider Demographics
NPI:1215294533
Name:TANO, DAVID R
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:TANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10798 SW 43RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4857
Mailing Address - Country:US
Mailing Address - Phone:786-718-7073
Mailing Address - Fax:305-709-6058
Practice Address - Street 1:14221 SW 120TH ST STE 225
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4225
Practice Address - Country:US
Practice Address - Phone:786-718-7073
Practice Address - Fax:305-709-6058
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011646363LP0808X
FL11011646363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health