Provider Demographics
NPI:1134933161
Name:TATUM, TASHA (RN, LPN)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:TATUM
Suffix:
Gender:F
Credentials:RN, LPN
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:DARLENE
Other - Last Name:TATUM-MARRISETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9787 SHADYMILL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1674
Mailing Address - Country:US
Mailing Address - Phone:661-220-9813
Mailing Address - Fax:
Practice Address - Street 1:250 PILOT RD STE 250
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-3514
Practice Address - Country:US
Practice Address - Phone:661-220-9813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-31
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV869360163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health