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General NPI Number Information
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NPI Number | 1346873817
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Entity Type | Individual
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Provider Name | TANISHA HENRY RN
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Gender | Female
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 1833 SW CAPEHART AVE
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-4606
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Country | US
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Telephone | 772-240-9417
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Fax | 772-673-8228
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Provider Business Mailing Address
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Address Line | 10380 SW VILLAGE CENTER DR # 188
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34987-1931
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Country | US
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Telephone | 772-240-9417
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Fax | 772-673-8228
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 9481114
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number | 9481114
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 9481114
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 9481114
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License Number State | FL
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