Provider Demographics
NPI:1790110443
Name:MBEKEM TANJONG, FLORENCE JINGWA
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:JINGWA
Last Name:MBEKEM TANJONG
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 1:1609 DREAM CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1576
Mailing Address - Country:US
Mailing Address - Phone:614-209-0250
Mailing Address - Fax:
Practice Address - Street 1:1609 DREAM CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1576
Practice Address - Country:US
Practice Address - Phone:614-209-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2024028452363LP0808X
OHNP-117004-MEDS164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse