Individual
MRS. TANNA TORCASO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
QP
Contact information
Practice address
303 STILLWATER CV, JACKSONVILLE, NC 28546-9790
(910) 219-1180
Mailing address
303 STILLWATER CV, JACKSONVILLE, NC 28546-9790
(910) 219-1180
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
MHL-067-118
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3409267
—
NC
Enumeration date
08/29/2006
Last updated
07/09/2007
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