Provider Demographics
NPI:1740832484
Name:LLOYD, TAQUISHA
Entity type:Individual
Prefix:MRS
First Name:TAQUISHA
Middle Name:
Last Name:LLOYD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAQUISHA
Other - Middle Name:
Other - Last Name:LLOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TAQUISHA JONES
Mailing Address - Street 1:6123 MEADOW VISTA LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-1125
Mailing Address - Country:US
Mailing Address - Phone:702-787-2488
Mailing Address - Fax:
Practice Address - Street 1:112 S WATER ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-2312
Practice Address - Country:US
Practice Address - Phone:702-787-2488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL84-2249312OtherINTERNAL REVENUE SERVICE
NV84-2249312OtherIRS