Provider Demographics
NPI:1376326710
Name:FLUTCH, TASHAUNA DENIESHA (CNA)
Entity Type:Individual
Prefix:
First Name:TASHAUNA
Middle Name:DENIESHA
Last Name:FLUTCH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:TASHAUNA
Other - Middle Name:DENIESHA
Other - Last Name:FLUTCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA
Mailing Address - Street 1:33 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-4148
Mailing Address - Country:US
Mailing Address - Phone:314-885-2553
Mailing Address - Fax:
Practice Address - Street 1:1095 CEDAR PL
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-4445
Practice Address - Country:US
Practice Address - Phone:314-885-2553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO12280A376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide