Provider Demographics
NPI:1265161780
Name:WALKER, TANEIA R
Entity type:Individual
Prefix:MS
First Name:TANEIA
Middle Name:R
Last Name:WALKER
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 1:4334 SW LAGRANGE ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-6857
Mailing Address - Country:US
Mailing Address - Phone:772-985-3978
Mailing Address - Fax:
Practice Address - Street 1:4334 SW LAGRANGE ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-6857
Practice Address - Country:US
Practice Address - Phone:772-985-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician