Provider Demographics
NPI:1396284485
Name:GONZALEZ, TANIA L (BSN RN)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:L
Last Name:GONZALEZ
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:L
Other - Last Name:SERAFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN RN
Mailing Address - Street 1:933 BRADBURY DR SE
Mailing Address - Street 2:SUITE 2222
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4374
Mailing Address - Country:US
Mailing Address - Phone:505-272-3120
Mailing Address - Fax:505-272-8060
Practice Address - Street 1:2600 YALE BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-994-7999
Practice Address - Fax:505-243-0366
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN80808163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse