Provider Demographics
NPI:1285010835
Name:ANDERSON, TACHAEANA ANTOINETTE (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:TACHAEANA
Middle Name:ANTOINETTE
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-1334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5979 VINELAND RD
Practice Address - Street 2:SUITE 109
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7800
Practice Address - Country:US
Practice Address - Phone:407-270-7702
Practice Address - Fax:407-270-7705
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9171322163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse