Provider Demographics
NPI:1356708630
Name:HUDSON, TASHA N (DNP, APRN, AGCNS-BC)
Entity type:Individual
Prefix:DR
First Name:TASHA
Middle Name:N
Last Name:HUDSON
Suffix:
Gender:
Credentials:DNP, APRN, AGCNS-BC
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:HUDSON
Other - Last Name:HAVINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1151 W MILHAM AVE UNIT 118
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49081-5006
Mailing Address - Country:US
Mailing Address - Phone:269-298-6285
Mailing Address - Fax:
Practice Address - Street 1:1151 W MILHAM AVE UNIT 118
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49081-5006
Practice Address - Country:US
Practice Address - Phone:269-298-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2025-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704372539363L00000X, 364SA2200X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health