Provider Demographics
NPI:1396806865
Name:PRICE, TASHA M (FNP)
Entity type:Individual
Prefix:MRS
First Name:TASHA
Middle Name:M
Last Name:PRICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 SYCAMORE TRL
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-7425
Mailing Address - Country:US
Mailing Address - Phone:806-433-2122
Mailing Address - Fax:
Practice Address - Street 1:61 WHITCHER ST NE STE 2100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1179
Practice Address - Country:US
Practice Address - Phone:770-423-0595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN244445363L00000X
TX677806363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186390401Medicaid