Provider Demographics
NPI:1043503634
Name:CLARK CULPEPPER, TANGELA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TANGELA
Middle Name:
Last Name:CLARK CULPEPPER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 MILLENNIUM PKWY
Mailing Address - Street 2:SUITE 122
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-3894
Mailing Address - Country:US
Mailing Address - Phone:813-438-8756
Mailing Address - Fax:813-438-8757
Practice Address - Street 1:1219 MILLENNIUM PKWY
Practice Address - Street 2:SUITE 122
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-3894
Practice Address - Country:US
Practice Address - Phone:813-438-8756
Practice Address - Fax:813-438-8757
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical