Provider Demographics
NPI:1619655990
Name:ENGLRUM, TARINA TAMEKA (CCMA)
Entity Type:Individual
Prefix:
First Name:TARINA
Middle Name:TAMEKA
Last Name:ENGLRUM
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 MALONE FERGUSON RD
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:SC
Mailing Address - Zip Code:29922
Mailing Address - Country:US
Mailing Address - Phone:803-842-6749
Mailing Address - Fax:
Practice Address - Street 1:813 MALONE FERGUSON RD
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:SC
Practice Address - Zip Code:29922
Practice Address - Country:US
Practice Address - Phone:803-842-6749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory