Provider Demographics
NPI:1356898001
Name:LIGON, TASHA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:LIGON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 PEAKS LANDING WAY
Mailing Address - Street 2:APT 103
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-7934
Mailing Address - Country:US
Mailing Address - Phone:865-237-8033
Mailing Address - Fax:
Practice Address - Street 1:4016 PEAKS LANDING WAY
Practice Address - Street 2:APT 103
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-7934
Practice Address - Country:US
Practice Address - Phone:865-237-8033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNX9R5D7L5364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNX9R5D7L5OtherCERTIFIED CLINICAL MEDICAL ASSISTANT