Provider Demographics
NPI:1831729946
Name:TARPLEY-TEDDER, TAWANDA L (CEO)
Entity type:Individual
Prefix:
First Name:TAWANDA
Middle Name:L
Last Name:TARPLEY-TEDDER
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12907 BUFFALO SPRINGS PL
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6914
Mailing Address - Country:US
Mailing Address - Phone:434-250-6273
Mailing Address - Fax:
Practice Address - Street 1:12907 BUFFALO SPRINGS PL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-6914
Practice Address - Country:US
Practice Address - Phone:434-250-6273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant