Provider Demographics
NPI:1659037810
Name:OVERMAN, TASHAUNA SHAE
Entity Type:Individual
Prefix:
First Name:TASHAUNA
Middle Name:SHAE
Last Name:OVERMAN
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 1:3447 E KRISTAL WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-6303
Mailing Address - Country:US
Mailing Address - Phone:928-660-1676
Mailing Address - Fax:
Practice Address - Street 1:10200 N 92ND ST STE 150
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4535
Practice Address - Country:US
Practice Address - Phone:928-660-1676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN192202163WC0200X
AZ270468363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine