Provider Demographics
NPI:1083192819
Name:TANIA MCLEAN ADULT & GERIATRIC PRIMARY CARE SERVICES, LLC
Entity Type:Organization
Organization Name:TANIA MCLEAN ADULT & GERIATRIC PRIMARY CARE SERVICES, LLC
Other - Org Name:QUALITY WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUREY MCLEAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:561-714-6059
Mailing Address - Street 1:4182 SW BAIRD ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3136
Mailing Address - Country:US
Mailing Address - Phone:561-714-6059
Mailing Address - Fax:
Practice Address - Street 1:4182 SW BAIRD ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3136
Practice Address - Country:US
Practice Address - Phone:561-714-6059
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty