Provider Demographics
NPI:1184322315
Name:BOYD, TENAEZHA
Entity type:Individual
Prefix:
First Name:TENAEZHA
Middle Name:
Last Name:BOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 W PROSPECT RD APT 31
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33309-4664
Mailing Address - Country:US
Mailing Address - Phone:239-778-2743
Mailing Address - Fax:
Practice Address - Street 1:999 W PROSPECT RD APT 31
Practice Address - Street 2:
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33309-4664
Practice Address - Country:US
Practice Address - Phone:239-778-2743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-17
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB300803887140OtherFLORIDA DRIVER LICENSE