Provider Demographics
NPI:1093965303
Name:GANO, TASHA TYLYNN
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:TYLYNN
Last Name:GANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 BRIGGS ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-2801
Mailing Address - Country:US
Mailing Address - Phone:585-309-8274
Mailing Address - Fax:
Practice Address - Street 1:39 BRIGGS ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-2801
Practice Address - Country:US
Practice Address - Phone:585-309-8274
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281058164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse