Provider Demographics
NPI:1912757824
Name:HUFFIN, TANETRIA D
Entity Type:Individual
Prefix:
First Name:TANETRIA
Middle Name:D
Last Name:HUFFIN
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 1:440 JASMINE WAY
Mailing Address - Street 2:
Mailing Address - City:BURGAW
Mailing Address - State:NC
Mailing Address - Zip Code:28425-4320
Mailing Address - Country:US
Mailing Address - Phone:272-336-4231
Mailing Address - Fax:
Practice Address - Street 1:502 N 4TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-3412
Practice Address - Country:US
Practice Address - Phone:272-336-4231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management