Individual
TAIRA DILALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3820 COLONIAL BLVD STE 102, FORT MYERS, FL 33966-1094
(239) 208-9449
Mailing address
3820 COLONIAL BLVD STE 102, FORT MYERS, FL 33966-1094
(239) 208-9449
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN1083581
FL
Other
Enumeration date
10/22/2015
Last updated
10/22/2015
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