Provider Demographics
NPI:1780149435
Name:MCBRIDE, TAUSHIA MONIQUE (AGNP-BC)
Entity type:Individual
Prefix:MISS
First Name:TAUSHIA
Middle Name:MONIQUE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:MISS
Other - First Name:TAUSHIA
Other - Middle Name:MONIQUE
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNP
Mailing Address - Street 1:1022 FOXCHASE LN
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MD
Mailing Address - Zip Code:21221-5901
Mailing Address - Country:US
Mailing Address - Phone:410-499-0139
Mailing Address - Fax:
Practice Address - Street 1:1022 FOXCHASE LN
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-5901
Practice Address - Country:US
Practice Address - Phone:410-499-0139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR197362363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR197362OtherNURSING LICENSE