Provider Demographics
NPI:1780214049
Name:HERNDON, TASHA NICHOLE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TASHA
Middle Name:NICHOLE
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 BLEVINS BLVD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202-5977
Mailing Address - Country:US
Mailing Address - Phone:276-698-6141
Mailing Address - Fax:
Practice Address - Street 1:284 BLEVINS BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202-5977
Practice Address - Country:US
Practice Address - Phone:276-285-3911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily