Provider Demographics
NPI:1952642134
Name:TASONG, ENESTINE AZENKENG (RN)
Entity Type:Individual
Prefix:MS
First Name:ENESTINE
Middle Name:AZENKENG
Last Name:TASONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 BENT MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-8197
Mailing Address - Country:US
Mailing Address - Phone:614-446-6016
Mailing Address - Fax:
Practice Address - Street 1:3000 CORPORATE EXCHANGE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-7689
Practice Address - Country:US
Practice Address - Phone:614-965-1866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH342944163W00000X
OH024574363LF0000X, 363LP0808X
WAAP61333403363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty