Provider Demographics
NPI:1083100184
Name:MCCORMICK, TENEEKA
Entity Type:Individual
Prefix:
First Name:TENEEKA
Middle Name:
Last Name:MCCORMICK
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 1:7228 CLARCONA OCOEE RD
Mailing Address - Street 2:
Mailing Address - City:CLARCONA
Mailing Address - State:FL
Mailing Address - Zip Code:32710-2000
Mailing Address - Country:US
Mailing Address - Phone:407-898-2225
Mailing Address - Fax:
Practice Address - Street 1:7228 CLARCONA OCOEE RD
Practice Address - Street 2:
Practice Address - City:CLARCONA
Practice Address - State:FL
Practice Address - Zip Code:32710-2000
Practice Address - Country:US
Practice Address - Phone:407-898-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021329600Medicaid