Provider Demographics
NPI:1487202560
Name:OLIVER, TAMECA LASHA (CRNP)
Entity Type:Individual
Prefix:
First Name:TAMECA
Middle Name:LASHA
Last Name:OLIVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 DELILAH LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35756-3580
Mailing Address - Country:US
Mailing Address - Phone:501-563-7684
Mailing Address - Fax:
Practice Address - Street 1:1304 13TH AVE SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4359
Practice Address - Country:US
Practice Address - Phone:800-508-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-31
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004939363LF0000X
AL1-184336363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily