Provider Demographics
NPI:1467152801
Name:WHITEHEAD, TA'SHARA T (RN)
Entity Type:Individual
Prefix:
First Name:TA'SHARA
Middle Name:T
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 56721
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-6721
Mailing Address - Country:US
Mailing Address - Phone:904-990-4774
Mailing Address - Fax:
Practice Address - Street 1:4411 SUNBEAM RD # 56721
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-7525
Practice Address - Country:US
Practice Address - Phone:904-990-4774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9560030163WG0600X, 163WH0200X, 163WS0200X, 163WW0000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WW0000XNursing Service ProvidersRegistered NurseWound Care