Provider Demographics
NPI:1003258120
Name:GOUIN, TASHA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:GOUIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 W POST RD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-2417
Mailing Address - Country:US
Mailing Address - Phone:702-430-5333
Mailing Address - Fax:
Practice Address - Street 1:9097 W POST RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-2417
Practice Address - Country:US
Practice Address - Phone:702-430-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ278402363LF0000X
OR201506922NP-PP363LF0000X
NV811768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily