Provider Demographics
NPI:1366732802
Name:TAFIE, ORTEASA MARIA (CNA)
Entity type:Individual
Prefix:MRS
First Name:ORTEASA
Middle Name:MARIA
Last Name:TAFIE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 SIX FLAGS DR
Mailing Address - Street 2:#1207
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-7065
Mailing Address - Country:US
Mailing Address - Phone:404-274-4498
Mailing Address - Fax:678-324-6791
Practice Address - Street 1:1325 SIX FLAGS DR
Practice Address - Street 2:#1207
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-7065
Practice Address - Country:US
Practice Address - Phone:404-274-4498
Practice Address - Fax:678-324-6791
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028902879376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide