Healthcare Provider Details

I. General information

NPI: 1073864617
Provider Name (Legal Business Name): TAFFY KATRINA WHITE MLS(ASCP)CM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2012
Last Update Date: 09/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3220 MOODY AVE
ORANGE PARK FL
32065-6809
US

IV. Provider business mailing address

3220 MOODY AVE
ORANGE PARK FL
32065-6809
US

V. Phone/Fax

Practice location:
  • Phone: 609-723-4657
  • Fax:
Mailing address:
  • Phone: 609-723-4657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License NumberTN42924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: