Healthcare Provider Details

I. General information

NPI: 1134575814
Provider Name (Legal Business Name): TANYA LEIMOMI KORT LICENSED PSYCHOLOGIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 NW 76TH DR
GAINESVILLE FL
32607-6668
US

IV. Provider business mailing address

264 NORCIA LOOP
LIBERTY HILL TX
78642
US

V. Phone/Fax

Practice location:
  • Phone: 352-505-6363
  • Fax: 352-505-6383
Mailing address:
  • Phone: 352-505-6363
  • Fax: 352-505-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number38133
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY8054
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: