Provider Demographics
NPI:1821979097
Name:PORTER, TALEESA
Entity type:Individual
Prefix:
First Name:TALEESA
Middle Name:
Last Name:PORTER
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 1:5658 HEYWARD SMALLS RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29449-5710
Mailing Address - Country:US
Mailing Address - Phone:843-302-5213
Mailing Address - Fax:855-403-7011
Practice Address - Street 1:5658 HEYWARD SMALLS RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:SC
Practice Address - Zip Code:29449-5710
Practice Address - Country:US
Practice Address - Phone:843-302-5213
Practice Address - Fax:855-403-7011
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-11
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty