Provider Demographics
NPI:1306376967
Name:TATASCIORE, LEAH ANN (RN PHCNS-BC CBIS)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:ANN
Last Name:TATASCIORE
Suffix:
Gender:F
Credentials:RN PHCNS-BC CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 CASS ST STE C
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4157
Mailing Address - Country:US
Mailing Address - Phone:231-932-0413
Mailing Address - Fax:231-929-0048
Practice Address - Street 1:1501 CASS ST STE C
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4157
Practice Address - Country:US
Practice Address - Phone:231-932-0413
Practice Address - Fax:231-929-0048
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242915163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice