Provider Demographics
NPI:1578268264
Name:HODGSON, TASHA A (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:A
Last Name:HODGSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 MENTOR AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8702
Mailing Address - Country:US
Mailing Address - Phone:440-352-4880
Mailing Address - Fax:
Practice Address - Street 1:9500 MENTOR AVE STE 100
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8702
Practice Address - Country:US
Practice Address - Phone:440-352-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0032926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily