Individual
TANEKA D WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3209 SW 34TH AVENUE CIR, OCALA, FL 34474-3372
(352) 789-6795
(352) 789-6796
Mailing address
3209 SW 34TH AVENUE CIR, OCALA, FL 34474-3372
(352) 789-6795
(352) 789-6796
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
690063196
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
690063196
—
FL
Enumeration date
10/07/2019
Last updated
10/07/2019
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