Provider Demographics
NPI:1699908582
Name:URENDA, TANIA ANN (ASCP)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:ANN
Last Name:URENDA
Suffix:
Gender:F
Credentials:ASCP
Other - Prefix:
Other - First Name:TANIA
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASCP
Mailing Address - Street 1:439 GRAY HORSE CIR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80863-8943
Mailing Address - Country:US
Mailing Address - Phone:850-259-8642
Mailing Address - Fax:
Practice Address - Street 1:439 GRAY HORSE CIR
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-8943
Practice Address - Country:US
Practice Address - Phone:850-259-8642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN 38271246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist