Provider Demographics
NPI:1467808584
Name:FOX, TASHIA I (APN)
Entity Type:Individual
Prefix:
First Name:TASHIA
Middle Name:I
Last Name:FOX
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TASHIA
Other - Middle Name:I
Other - Last Name:SZYMCEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:6294 STATE HIGHWAY 154
Practice Address - Street 2:
Practice Address - City:SESSER
Practice Address - State:IL
Practice Address - Zip Code:62884-2163
Practice Address - Country:US
Practice Address - Phone:618-625-6979
Practice Address - Fax:618-625-6549
Is Sole Proprietor?:No
Enumeration Date:2016-05-07
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041354357163W00000X
IL309009913363L00000X
IL209014272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner