Provider Demographics
NPI:1205206729
Name:BATTEN, TENNILLE
Entity Type:Individual
Prefix:
First Name:TENNILLE
Middle Name:
Last Name:BATTEN
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 1:11247 SAN JOSE BLVD
Mailing Address - Street 2:APT 1916
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7948
Mailing Address - Country:US
Mailing Address - Phone:904-755-1742
Mailing Address - Fax:
Practice Address - Street 1:11247 SAN JOSE BLVD
Practice Address - Street 2:APT 1916
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7948
Practice Address - Country:US
Practice Address - Phone:904-755-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-26
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24566225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant