Provider Demographics
NPI:1073864617
Name:WHITE, TAFFY KATRINA (MLS(ASCP)CM)
Entity Type:Individual
Prefix:MRS
First Name:TAFFY
Middle Name:KATRINA
Last Name:WHITE
Suffix:
Gender:F
Credentials:MLS(ASCP)CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 MOODY AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-6809
Mailing Address - Country:US
Mailing Address - Phone:609-723-4657
Mailing Address - Fax:
Practice Address - Street 1:3220 MOODY AVE
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-6809
Practice Address - Country:US
Practice Address - Phone:609-723-4657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-23
Last Update Date:2012-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTN42924246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist