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General NPI Number Information
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NPI Number | 1235594862
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Entity Type | Individual
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Provider Name | TAZZIE HARRISON MCLEOD APRN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/26/2015
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 7765 S COUNTY ROAD 231
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City | LAKE BUTLER
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State | FL
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Zip | 32054-5721
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Country | US
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Telephone | 352-494-6692
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Fax | 352-558-3422
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Provider Business Mailing Address
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Address Line | 2380 SE 43RD ST
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City | KEYSTONE HEIGHTS
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State | FL
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Zip | 32656-5822
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Country | US
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Telephone | 352-494-6692
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Fax | 352-558-3422
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11011283
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9383966
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License Number State | FL
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