Provider Demographics
NPI:1740507383
Name:PIERCE, TASHA SHERITA (LPN)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:SHERITA
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W SYLVANIA AVE
Mailing Address - Street 2:319A
Mailing Address - City:NEPTUNE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6056
Mailing Address - Country:US
Mailing Address - Phone:732-766-2472
Mailing Address - Fax:732-361-7784
Practice Address - Street 1:301 W SYLVANIA AVE
Practice Address - Street 2:319A
Practice Address - City:NEPTUNE CITY
Practice Address - State:NJ
Practice Address - Zip Code:07753-6056
Practice Address - Country:US
Practice Address - Phone:732-766-2472
Practice Address - Fax:732-361-7784
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP06192100164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse