Provider Demographics
NPI:1053133157
Name:TAVERAS, NORMA JUNE (NP)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:JUNE
Last Name:TAVERAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N CEDAR ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6453
Mailing Address - Country:US
Mailing Address - Phone:843-821-2480
Mailing Address - Fax:
Practice Address - Street 1:204 N CEDAR ST STE 100
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6453
Practice Address - Country:US
Practice Address - Phone:843-821-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29585363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health