Basic Information
| Provider Information | |||||||||
| NPI: | 1750836805 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | TASHA | ||||||||
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| Credential: | MSN.FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 BRADFORD DR | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGDALE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313024926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146796042 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1150 CORNELL AVE | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314062702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123543911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2016 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN214154 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.