Provider Demographics
NPI:1053626978
Name:LONG, TASHA (RN)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:LONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 N COUNTY ROAD 1138
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-9417
Mailing Address - Country:US
Mailing Address - Phone:432-413-6205
Mailing Address - Fax:
Practice Address - Street 1:3303 W ILLINOIS AVE
Practice Address - Street 2:SUITE 22
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79703-6213
Practice Address - Country:US
Practice Address - Phone:432-681-7625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX766730163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health