Provider Demographics
NPI:1669296935
Name:WHITTINGTON, TAHIRA IMANI (BSN)
Entity type:Individual
Prefix:
First Name:TAHIRA
Middle Name:IMANI
Last Name:WHITTINGTON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 JOHN PAUL JONES CIR BLDG 1
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708-2210
Mailing Address - Country:US
Mailing Address - Phone:757-953-0495
Mailing Address - Fax:
Practice Address - Street 1:620 JOHN PAUL JONES CIR STE 275
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2197
Practice Address - Country:US
Practice Address - Phone:757-953-0495
Practice Address - Fax:757-953-7478
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001325172163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty