Provider Demographics
NPI:1639958317
Name:NEAL, TANISHIA (NBHWC, RN)
Entity Type:Individual
Prefix:
First Name:TANISHIA
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:NBHWC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11663 SAVONA WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7241
Mailing Address - Country:US
Mailing Address - Phone:734-629-7737
Mailing Address - Fax:
Practice Address - Street 1:11663 SAVONA WAY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7241
Practice Address - Country:US
Practice Address - Phone:734-629-7737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-3772154171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach