Provider Demographics
NPI:1598491664
Name:CRAFTON, TASHA
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:CRAFTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 N LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-4428
Mailing Address - Country:US
Mailing Address - Phone:302-332-3683
Mailing Address - Fax:
Practice Address - Street 1:501 EDGE HILL RD APT B2
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-2542
Practice Address - Country:US
Practice Address - Phone:302-442-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA55233601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health