Provider Demographics
NPI:1023699378
Name:HOLLIE-LOVE, TAYENTA RENEA
Entity type:Individual
Prefix:
First Name:TAYENTA
Middle Name:RENEA
Last Name:HOLLIE-LOVE
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 1:4325 W ROME BLVD APT 3196
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89084-5493
Mailing Address - Country:US
Mailing Address - Phone:702-881-3103
Mailing Address - Fax:
Practice Address - Street 1:8745 CASTLE VIEW AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7681
Practice Address - Country:US
Practice Address - Phone:702-749-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker