Provider Demographics
NPI:1487762373
Name:TORCASO, TANNA (QP)
Entity type:Individual
Prefix:MRS
First Name:TANNA
Middle Name:
Last Name:TORCASO
Suffix:
Gender:F
Credentials:QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 STILLWATER CV
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9790
Mailing Address - Country:US
Mailing Address - Phone:910-219-1180
Mailing Address - Fax:
Practice Address - Street 1:303 STILLWATER CV
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-9790
Practice Address - Country:US
Practice Address - Phone:910-219-1180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-067-118320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3409267Medicaid