Provider Demographics
NPI:1295582294
Name:TATE, TAWANNA NICHOLE
Entity type:Individual
Prefix:MS
First Name:TAWANNA
Middle Name:NICHOLE
Last Name:TATE
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 1:110 S BLACKSTOCK RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-2556
Mailing Address - Country:US
Mailing Address - Phone:864-417-4920
Mailing Address - Fax:
Practice Address - Street 1:110 S BLACKSTOCK RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2556
Practice Address - Country:US
Practice Address - Phone:864-417-4920
Practice Address - Fax:864-216-8067
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide