Clark, Tanisha Tiana

Clark, Tanisha Tiana is an sole proprietor health care provider with primary practice located at 333 Christian St , Wallingford CT 06492-3818. She recently has 2 registered licenses in different health care specialties including Student, Health Care / Student in an Organized Health Care Education/Training Program, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer is her primary health care specialty. Clark, Tanisha Tiana can be contacted via phone (203) 697-2983.

Contact Information

Primary practice address
333 Christian St Wallingford CT 06492-3818
Phone: (203) 697-2983
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 54.001470 Connecticut
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X

Profile Details

NPI number 1871095935
LBN Legal business name Clark, Tanisha Tiana
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 5th, 2018
Last updated Feb 15th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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