Healthcare Provider Details

I. General information

NPI: 1942138722
Provider Name (Legal Business Name): TESA TAJU PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7916 EVOLUTIONS WAY STE 102
TRINITY FL
34655-9900
US

IV. Provider business mailing address

7916 EVOLUTIONS WAY STE 102
TRINITY FL
34655-9900
US

V. Phone/Fax

Practice location:
  • Phone: 727-910-5990
  • Fax:
Mailing address:
  • Phone: 727-910-5990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11046080
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: