Provider Demographics
NPI:1235866682
Name:ISAACS, TANETTA ROSLYN
Entity Type:Individual
Prefix:
First Name:TANETTA
Middle Name:ROSLYN
Last Name:ISAACS
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:PO BOX 667351
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28266-7351
Mailing Address - Country:US
Mailing Address - Phone:980-288-5698
Mailing Address - Fax:
Practice Address - Street 1:1425 LUTHER ST APT 102
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3492
Practice Address - Country:US
Practice Address - Phone:980-288-5698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner