Provider Demographics
NPI:1598018848
Name:BATTEY, TIA JESSICA (EDS)
Entity Type:Individual
Prefix:MS
First Name:TIA
Middle Name:JESSICA
Last Name:BATTEY
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17432 TAILFEATHER CT
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5911
Mailing Address - Country:US
Mailing Address - Phone:407-905-9450
Mailing Address - Fax:
Practice Address - Street 1:17432 TAILFEATHER CT
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5911
Practice Address - Country:US
Practice Address - Phone:407-905-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL$$$$$$$$$OtherITDS