Individual
TIAJUANA BANKSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSING ASSISTANCE
Contact information
Practice address
7601 RAMONA ST, MIRAMAR, FL 33023-2534
(786) 565-2414
Mailing address
7601 RAMONA ST, MIRAMAR, FL 33023-2534
(786) 565-2414
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
231312
FL
Other
Enumeration date
11/21/2013
Last updated
11/21/2013
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