Provider Demographics
NPI:1568259661
Name:LAGUERRE, TANIA ANNIE
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:ANNIE
Last Name:LAGUERRE
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 1:1457 SUMMIT OAKS DR W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-5205
Mailing Address - Country:US
Mailing Address - Phone:210-931-1003
Mailing Address - Fax:
Practice Address - Street 1:782 FOXRIDGE CENTER DR
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-5776
Practice Address - Country:US
Practice Address - Phone:904-637-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-24-354984106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician