Provider Demographics
NPI:1538356720
Name:MILLS, TANESHA DEANNA
Entity type:Individual
Prefix:
First Name:TANESHA
Middle Name:DEANNA
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E SILVER SPRINGS BLVD
Mailing Address - Street 2:SUITE121
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-6831
Mailing Address - Country:US
Mailing Address - Phone:352-484-2055
Mailing Address - Fax:
Practice Address - Street 1:1515 EAST SILVER SPRINGS BOULEVARD
Practice Address - Street 2:SUITE 121
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-2934
Practice Address - Country:US
Practice Address - Phone:352-390-8875
Practice Address - Fax:352-390-8895
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL692013696172V00000X
FLMA67407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No172V00000XOther Service ProvidersCommunity Health Worker