Tanae'Ja Burroughs
Student in an Organized Health Care Education/Training Program in Jacksonville, FL. Individual provider (NPI-1).
NPI number1760105613
StatusActive
Last updated in NPPESSep 26, 2022
Details
- NPI
- 1760105613
- Entity type
- Individual (NPI-1)
- Name
- Tanae'Ja Burroughs
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Sep 26, 2022
- Certification date
- Sep 24, 2022
- Last updated
- Sep 26, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 390200000X | Student in an Organized Health Care Education/Training Program | – | – | Yes |
Practice location
5207 Normandy BlvdJacksonville, FL 32205-4827
Phone 904-786-4639
Mailing address
5207 Normandy BlvdJacksonville, FL 32205-4827
Phone 904-786-4639
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