Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003453101 |
---|---|
Provider Name | Tanisha Michelle Milligan |
First Address | Port St Lucie, FL 34988-0014 |
Second Address | Port St Lucie, FL 34953-4719 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2019 |
Last Update Date | 08/12/2019 |