Provider Demographics
NPI:1629538780
Name:PORTER, TANEKA LAVETTE (NP)
Entity Type:Individual
Prefix:MRS
First Name:TANEKA
Middle Name:LAVETTE
Last Name:PORTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 PARDUCCI TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8126
Mailing Address - Country:US
Mailing Address - Phone:901-517-6256
Mailing Address - Fax:
Practice Address - Street 1:381 PARDUCCI TRL
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8126
Practice Address - Country:US
Practice Address - Phone:901-517-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-23
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN246860363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily