Provider Demographics
NPI:1013420298
Name:HASON, TATANISHA (APN)
Entity Type:Individual
Prefix:
First Name:TATANISHA
Middle Name:
Last Name:HASON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3910
Mailing Address - Country:US
Mailing Address - Phone:856-227-6575
Mailing Address - Fax:856-374-9465
Practice Address - Street 1:400 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-3910
Practice Address - Country:US
Practice Address - Phone:856-227-6575
Practice Address - Fax:856-374-9465
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00769500363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily