Provider Demographics
NPI:1235594862
Name:MCLEOD, TAZZIE HARRISON (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TAZZIE
Middle Name:HARRISON
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2380 SE 43RD ST
Mailing Address - Street 2:
Mailing Address - City:KEYSTONE HEIGHTS
Mailing Address - State:FL
Mailing Address - Zip Code:32656-5822
Mailing Address - Country:US
Mailing Address - Phone:352-494-6692
Mailing Address - Fax:352-558-3422
Practice Address - Street 1:7765 S COUNTY ROAD 231
Practice Address - Street 2:
Practice Address - City:LAKE BUTLER
Practice Address - State:FL
Practice Address - Zip Code:32054-5721
Practice Address - Country:US
Practice Address - Phone:352-494-6692
Practice Address - Fax:352-558-3422
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-26
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9383966163W00000X
FLAPRN11011283363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty