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General NPI Number Information
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NPI Number | 1811555220
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Entity Type | Individual
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Provider Name | TANISHA OKONJI M.ED, RBT
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Gender | Female
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Dates
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Enumeration Date | 05/31/2019
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 3707 SILVER BLUFF BLVD
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City | ORANGE PARK
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State | FL
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Zip | 32065-4238
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Country | US
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Telephone | 904-450-9390
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Fax |
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Provider Business Mailing Address
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Address Line | 3707 SILVER BLUFF BLVD
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City | ORANGE PARK
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State | FL
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Zip | 32065-4238
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Country | US
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Telephone | 904-450-9390
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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 | 247000000X
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Taxonomy Name | Health Information Technician
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License Number | RBT-19-87832
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-45941
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License Number State |
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