Provider Demographics
NPI:1366962284
Name:TAPANES, ALBA CELESTE (SW-5859)
Entity type:Individual
Prefix:
First Name:ALBA
Middle Name:CELESTE
Last Name:TAPANES
Suffix:
Gender:F
Credentials:SW-5859
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34514 SW 187TH CT # 239
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33034-4542
Mailing Address - Country:US
Mailing Address - Phone:786-346-2681
Mailing Address - Fax:
Practice Address - Street 1:34514 SW 187TH CT
Practice Address - Street 2:# 239
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33034-4542
Practice Address - Country:US
Practice Address - Phone:954-210-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-58591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021323900Medicaid
FLSW-5859OtherDEPARTMENT OF HEALTH