Provider Demographics
NPI:1093536898
Name:MCCANE, TEENA K (CHNP)
Entity type:Individual
Prefix:
First Name:TEENA
Middle Name:K
Last Name:MCCANE
Suffix:
Gender:F
Credentials:CHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181391
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32718-1391
Mailing Address - Country:US
Mailing Address - Phone:321-947-8536
Mailing Address - Fax:
Practice Address - Street 1:109 CARRIAGE HILL DR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-4952
Practice Address - Country:US
Practice Address - Phone:321-947-8536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education