Provider Demographics
NPI:1881241040
Name:DOUGLAS, TANISHA
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:DOUGLAS
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 1:5278 MARLBORO PIKE APT 304
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5468
Mailing Address - Country:US
Mailing Address - Phone:301-728-2816
Mailing Address - Fax:
Practice Address - Street 1:919 VARNEY ST SE UNIT B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4330
Practice Address - Country:US
Practice Address - Phone:301-728-2816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant