Provider Demographics
NPI:1407495682
Name:THOMAS, TASHA OLIVIA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:OLIVIA
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:TASHA
Other - Middle Name:OLIVIA
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7494 SW 10TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33068-2319
Mailing Address - Country:US
Mailing Address - Phone:678-468-6755
Mailing Address - Fax:
Practice Address - Street 1:1001 WEST ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:NY
Practice Address - Zip Code:13619-9703
Practice Address - Country:US
Practice Address - Phone:315-493-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-05
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife