Healthcare Provider Details

I. General information

NPI: 1912462615
Provider Name (Legal Business Name): TAMIQUA MONIQUE TORRES IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N DENNING DR
WINTER PARK FL
32789-3019
US

IV. Provider business mailing address

630 N DENNING DR
WINTER PARK FL
32789-3019
US

V. Phone/Fax

Practice location:
  • Phone: 407-734-1021
  • Fax:
Mailing address:
  • Phone: 407-734-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL305955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: