Provider Demographics
NPI:1841835345
Name:EDWARDS, TASHUA SHANTA
Entity type:Individual
Prefix:
First Name:TASHUA
Middle Name:SHANTA
Last Name:EDWARDS
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 1:1751 LASCASSAS PIKE APT F93
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2132
Mailing Address - Country:US
Mailing Address - Phone:731-487-9103
Mailing Address - Fax:
Practice Address - Street 1:1751 LASCASSAS PIKE APT F93
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2132
Practice Address - Country:US
Practice Address - Phone:731-487-9103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-08
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNI000000025447253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care