Provider Demographics
NPI:1689368748
Name:TAZIWA, SHARON (PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:
Last Name:TAZIWA
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5211 RED BURR OAK TRL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2661
Mailing Address - Country:US
Mailing Address - Phone:508-733-1234
Mailing Address - Fax:
Practice Address - Street 1:5211 RED BURR OAK TRL
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-2661
Practice Address - Country:US
Practice Address - Phone:508-733-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1086713363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health