Healthcare Provider Details

I. General information

NPI: 1811555220
Provider Name (Legal Business Name): TANISHA OKONJI M.ED, RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3707 SILVER BLUFF BLVD
ORANGE PARK FL
32065-4238
US

IV. Provider business mailing address

3707 SILVER BLUFF BLVD
ORANGE PARK FL
32065-4238
US

V. Phone/Fax

Practice location:
  • Phone: 904-450-9390
  • Fax:
Mailing address:
  • Phone: 904-450-9390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberRBT-19-87832
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-45941
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: