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General NPI Number Information
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NPI Number | 1740043876
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Entity Type | Organization
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Legal Business Name | COLORFUL JOURNEY TELEPSYCHIATRY, L.L.C.
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Dates
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Enumeration Date | 02/01/2024
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 113 SOUTH MONROE STREET 1ST FLOOR
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City | TALLAHASSEE
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State | FL
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Zip | 32301
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Country | US
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Telephone | 850-775-9345
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Fax |
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Provider Business Mailing Address
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Address Line | 113 SOUTH MONROE STREET 1ST FLOOR
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City | TALLAHASSEE
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State | FL
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Zip | 32301
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC MENTAL HEALTH NURSE PRA
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Name | CLAIRE JOY TIGLAD
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Credential | DNP, APRN
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Telephone | 850-775-9345
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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 |
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License Number State |
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