Provider Demographics
NPI:1760900666
Name:SKINNER, TASHA M (AGACNP)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:M
Last Name:SKINNER
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR STE 2300
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86 OMEGA DR BLDG B-86
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2065
Practice Address - Country:US
Practice Address - Phone:302-623-1929
Practice Address - Fax:302-366-1075
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0000227363L00000X
PARN680358163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse