Provider Demographics
NPI:1871350249
Name:HILLIARD, TANESHA
Entity type:Individual
Prefix:
First Name:TANESHA
Middle Name:
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 SPENCER LAKES DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-2864
Mailing Address - Country:US
Mailing Address - Phone:817-877-6196
Mailing Address - Fax:
Practice Address - Street 1:4900 SPENCER LAKES DR APT 1132
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001-2863
Practice Address - Country:US
Practice Address - Phone:817-877-6196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)