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Tiara Lei Funkhouser

NPI Registration Record

Provider / OrganizationNPIDate Certified
TIARA LEI FUNKHOUSER13065787862022-06-25

Tiara Lei Funkhouser is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1306578786. Registration indicates Tiara Lei Funkhouser is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care)

Entity TypeIndividual
Provider Name Tiara Lei Funkhouser
Practice Office Address4523 DELTA AVE
JACKSONVILLE, FL US
Practice Office Telephone7543670080
Mailing Address4523 DELTA AVE
JACKSONVILLE, FL 322055106 US
Business Telephone7543670080
HPT Codes
CodePractice
License No
State
390200000X PRIMARY
Student, Health Care
Student in an Organized Health Care Education/Training Program
Student in an Organized Health Care Education/Training Program

All Other Specialties & Provider Types

Student in an Organized Health Care Education/Training Program
Student, Health Care
OPI Codes
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