Provider Demographics
NPI:1346631652
Name:EDWARDS, TAQUISHA DAWN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:TAQUISHA
Middle Name:DAWN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 E. 9TH STREET NORTH
Mailing Address - Street 2:BLDG 4970, ROOM 124
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314
Mailing Address - Country:US
Mailing Address - Phone:912-320-9125
Mailing Address - Fax:
Practice Address - Street 1:703 E. 9TH STREET NORTH
Practice Address - Street 2:BLDG 4970, ROOM 124
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-320-9125
Practice Address - Fax:912-435-6133
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695726163WC0400X
LA114257163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management