Provider Demographics
NPI:1154020501
Name:SPACKMAN, TAHSHA T (WHNP-BC)
Entity type:Individual
Prefix:
First Name:TAHSHA
Middle Name:T
Last Name:SPACKMAN
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7224 N SKYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6289
Mailing Address - Country:US
Mailing Address - Phone:208-851-1987
Mailing Address - Fax:
Practice Address - Street 1:7224 N SKYVIEW LN
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-6289
Practice Address - Country:US
Practice Address - Phone:208-851-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14173553-4405363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health