Provider Demographics
NPI:1578234712
Name:CAMACHO RODRIGUEZ, TANISHA LEE (NP)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:LEE
Last Name:CAMACHO RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:24 N WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:FEEDING HILLS
Practice Address - State:MA
Practice Address - Zip Code:01030-1606
Practice Address - Country:US
Practice Address - Phone:413-831-7831
Practice Address - Fax:413-831-7832
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2318093363LF0000X
CT10075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily