Provider Demographics
NPI:1679710040
Name:SCHULTZ, TASHA N (NP)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:N
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:N
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:100 TUPELO TRL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6911
Mailing Address - Country:US
Mailing Address - Phone:225-603-9535
Mailing Address - Fax:
Practice Address - Street 1:2324 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-3398
Practice Address - Country:US
Practice Address - Phone:912-756-2531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-07
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN220642363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201316102Medicaid
TX201316103Medicaid
TX201316101Medicaid
TX201316103Medicaid
TX8L10941Medicare PIN
TX8L10940Medicare PIN