Provider Demographics
NPI:1538719653
Name:WRIGHT, TANIA K
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:K
Last Name:WRIGHT
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 1:1055 S HIAWASSEE RD APT 2024
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1855
Mailing Address - Country:US
Mailing Address - Phone:407-873-4243
Mailing Address - Fax:
Practice Address - Street 1:1300 S DUNCAN DR BLDG D
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4206
Practice Address - Country:US
Practice Address - Phone:352-742-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty