Provider Demographics
NPI:1306610183
Name:ADAKAI FOTU, TARALYN BLAINE
Entity type:Individual
Prefix:
First Name:TARALYN
Middle Name:BLAINE
Last Name:ADAKAI FOTU
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 1:4100 S PINELAKE WAY UNIT 116
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-5694
Mailing Address - Country:US
Mailing Address - Phone:480-466-4957
Mailing Address - Fax:
Practice Address - Street 1:4100 S PINELAKE WAY UNIT 116
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-5694
Practice Address - Country:US
Practice Address - Phone:480-466-4957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN196907163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse