Provider Demographics
NPI:1376310052
Name:COULSON, TASHEKIA KADEEN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:TASHEKIA
Middle Name:KADEEN
Last Name:COULSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:MISS
Other - First Name:TASHEKIA
Other - Middle Name:KADEEN
Other - Last Name:COULSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:3060 LA MIRAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4246
Mailing Address - Country:US
Mailing Address - Phone:954-850-8218
Mailing Address - Fax:
Practice Address - Street 1:2001 NE 48TH CT STE 4
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4512
Practice Address - Country:US
Practice Address - Phone:954-771-3929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11024082363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology