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General NPI Number Information
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NPI Number | 1538356720
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Entity Type | Individual
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Provider Name | TANESHA DEANNA MILLS
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Gender | Female
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 1515 EAST SILVER SPRINGS BOULEVARD SUITE 121
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City | OCALA
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State | FL
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Zip | 34474-2934
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Country | US
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Telephone | 352-390-8875
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Fax | 352-390-8895
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Provider Business Mailing Address
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Address Line | 1515 E SILVER SPRINGS BLVD SUITE121
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City | OCALA
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State | FL
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Zip | 34470-6831
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Country | US
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Telephone | 352-484-2055
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Fax |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 692013696
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA67407
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License Number State | FL
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