Healthcare Provider Details

I. General information

NPI: 1619124575
Provider Name (Legal Business Name): TANEKA M PAYNE L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9785 CROSSHILL BLVD STE 108
JACKSONVILLE FL
32222-5889
US

IV. Provider business mailing address

7101 WATER ROSE CT
JACKSONVILLE FL
32219-4376
US

V. Phone/Fax

Practice location:
  • Phone: 904-772-6522
  • Fax:
Mailing address:
  • Phone: 954-459-1059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA95213
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: