Provider Demographics
NPI:1124539739
Name:MCNEILLY, TJUANA YOLANDRA (RN)
Entity type:Individual
Prefix:
First Name:TJUANA
Middle Name:YOLANDRA
Last Name:MCNEILLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E MORENO ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-5257
Mailing Address - Country:US
Mailing Address - Phone:850-450-6074
Mailing Address - Fax:
Practice Address - Street 1:301 E MORENO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-5257
Practice Address - Country:US
Practice Address - Phone:850-450-6074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services