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General NPI Number Information
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NPI Number | 1821979097
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Entity Type | Individual
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Provider Name | TALEESA PORTER
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Gender | Female
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Dates
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Enumeration Date | 09/11/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 5658 HEYWARD SMALLS RD
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City | HOLLYWOOD
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State | SC
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Zip | 29449-5710
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Country | US
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Telephone | 843-302-5213
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Fax | 855-403-7011
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Provider Business Mailing Address
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Address Line | 5658 HEYWARD SMALLS RD
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City | HOLLYWOOD
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State | SC
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Zip | 29449-5710
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Country | US
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Telephone | 843-302-5213
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Fax | 855-403-7011
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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