Provider Demographics
NPI:1417655630
Name:BAILEY, TANISHA (RN)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4425 PORTSMOUTH BLVD STE 210A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-2152
Mailing Address - Country:US
Mailing Address - Phone:757-228-6003
Mailing Address - Fax:
Practice Address - Street 1:4425 PORTSMOUTH BLVD STE 210A
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-2152
Practice Address - Country:US
Practice Address - Phone:757-228-6003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-16
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001307384163WH0200X
VAHCO2532303747P1801X, 251E00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No385H00000XRespite Care FacilityRespite Care