Provider Demographics
NPI:1588848477
Name:SMITH, TASHA CAROL
Entity Type:Individual
Prefix:MS
First Name:TASHA
Middle Name:CAROL
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:CAROL
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:6947 CEDAR PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19138-2001
Mailing Address - Country:US
Mailing Address - Phone:215-276-1073
Mailing Address - Fax:
Practice Address - Street 1:6947 CEDARPARK AVENUE
Practice Address - Street 2:
Practice Address - City:PHIADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138
Practice Address - Country:US
Practice Address - Phone:215-276-1073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN254827L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse