Provider Demographics
NPI:1689074114
Name:JENNINGS, TASHA (ARNP)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:VISSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 9TH AVE N # 277
Mailing Address - Street 2:
Mailing Address - City:SIBLEY
Mailing Address - State:IA
Mailing Address - Zip Code:51249-1012
Mailing Address - Country:US
Mailing Address - Phone:712-754-3658
Mailing Address - Fax:712-754-2634
Practice Address - Street 1:600 9TH AVE N
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-1012
Practice Address - Country:US
Practice Address - Phone:712-754-3658
Practice Address - Fax:712-754-2634
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA122149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA122149OtherIOWA BOARD OF NURSING