Provider Demographics
NPI:1720376551
Name:CUNNINGHAM, TANYA NICOLE (LMT,CST)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:NICOLE
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LMT,CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 N US HIGHWAY 441
Mailing Address - Street 2:SUITE 530
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8975
Mailing Address - Country:US
Mailing Address - Phone:352-750-9069
Mailing Address - Fax:
Practice Address - Street 1:1400 N US HIGHWAY 441
Practice Address - Street 2:SUITE 530
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8975
Practice Address - Country:US
Practice Address - Phone:352-750-9069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0022140225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist