Provider Demographics
NPI:1467865428
Name:HARRISON, TASHEIMA (FNP)
Entity Type:Individual
Prefix:
First Name:TASHEIMA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1046 GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3620
Mailing Address - Country:US
Mailing Address - Phone:718-810-8640
Mailing Address - Fax:
Practice Address - Street 1:1046 GARDEN PL
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3620
Practice Address - Country:US
Practice Address - Phone:718-810-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-07
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY562355163WN0002X
NY340032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care