Provider Demographics
NPI:1043982176
Name:BRADSHAW, TARNISHA DIANE (DSP, PCA)
Entity Type:Individual
Prefix:MRS
First Name:TARNISHA
Middle Name:DIANE
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:DSP, PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12200 GLADE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-6281
Mailing Address - Country:US
Mailing Address - Phone:540-760-3946
Mailing Address - Fax:
Practice Address - Street 1:12200 GLADE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-6281
Practice Address - Country:US
Practice Address - Phone:540-760-3946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion