Provider Demographics
NPI:1750836805
Name:WALKER, TASHA (MSNFNP-C)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSNFNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BRADFORD DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:GA
Mailing Address - Zip Code:31302-4926
Mailing Address - Country:US
Mailing Address - Phone:614-679-6042
Mailing Address - Fax:
Practice Address - Street 1:1150 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2702
Practice Address - Country:US
Practice Address - Phone:912-354-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN214154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily