Provider Demographics
NPI:1013761527
Name:DAVIS, TASHA NICOLE (DOULA)
Entity Type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9823 EBYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46835-9742
Mailing Address - Country:US
Mailing Address - Phone:571-298-7618
Mailing Address - Fax:
Practice Address - Street 1:916 W COLISEUM BLVD STE G
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-1291
Practice Address - Country:US
Practice Address - Phone:571-298-7618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN171400000X, 174N00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171400000XOther Service ProvidersHealth & Wellness Coach
No174N00000XOther Service ProvidersLactation Consultant, Non-RN