Provider Demographics
NPI:1982001699
Name:MEADE, TENNYSON (RN)
Entity Type:Individual
Prefix:MR
First Name:TENNYSON
Middle Name:
Last Name:MEADE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-0523
Mailing Address - Country:US
Mailing Address - Phone:407-322-4317
Mailing Address - Fax:
Practice Address - Street 1:1310 S PARK AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-3464
Practice Address - Country:US
Practice Address - Phone:407-322-4317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 26934623747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL141377500Medicaid