Provider Demographics
NPI:1366034753
Name:TEJADA, JATNA
Entity Type:Individual
Prefix:MRS
First Name:JATNA
Middle Name:
Last Name:TEJADA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JATNA
Other - Middle Name:
Other - Last Name:TEJADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:61 TROTTERS CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-7729
Mailing Address - Country:US
Mailing Address - Phone:407-791-7921
Mailing Address - Fax:
Practice Address - Street 1:5449 S SEMORAN BLVD # 3
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1722
Practice Address - Country:US
Practice Address - Phone:407-734-1273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101Y00000X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No101Y00000XBehavioral Health & Social Service ProvidersCounselor