Provider Demographics
NPI:1003453101
Name:MILLIGAN, TANISHA MICHELLE
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:MICHELLE
Last Name:MILLIGAN
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:PO BOX 880014
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988-0014
Mailing Address - Country:US
Mailing Address - Phone:910-376-2228
Mailing Address - Fax:
Practice Address - Street 1:3260 SW ROSSER BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4719
Practice Address - Country:US
Practice Address - Phone:910-376-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-08
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker