Provider Demographics
NPI:1386428266
Name:BULLOCK, TANQUAZIA
Entity type:Individual
Prefix:
First Name:TANQUAZIA
Middle Name:
Last Name:BULLOCK
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 1:3134 BRINKLEY RD APT 101
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6347
Mailing Address - Country:US
Mailing Address - Phone:202-276-4289
Mailing Address - Fax:
Practice Address - Street 1:2 M ST NE APT 817
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3990
Practice Address - Country:US
Practice Address - Phone:202-579-2810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant