Provider Demographics
NPI:1316678030
Name:TAVIRA, KARINA A (PTA)
Entity type:Individual
Prefix:
First Name:KARINA
Middle Name:A
Last Name:TAVIRA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1730 DEBBIE DR
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-9421
Mailing Address - Country:US
Mailing Address - Phone:863-248-9849
Mailing Address - Fax:
Practice Address - Street 1:202 AVENUE O NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2409
Practice Address - Country:US
Practice Address - Phone:863-293-3103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNA208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation