Provider Demographics
NPI:1154718203
Name:MAUL, TANESIA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TANESIA
Middle Name:
Last Name:MAUL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6910 SOUTHERN OAKS DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-3685
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 482 BOX 52
Practice Address - Street 2:
Practice Address - City:OKINAWA
Practice Address - State:OKINAWA
Practice Address - Zip Code:96362
Practice Address - Country:JP
Practice Address - Phone:098-970-7191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52212183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist