Provider Demographics
NPI:1487435376
Name:USHER, TAJE (FNP-BC)
Entity type:Individual
Prefix:
First Name:TAJE
Middle Name:
Last Name:USHER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 MARINA LAKE RD APT 107
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-2027
Mailing Address - Country:US
Mailing Address - Phone:585-490-7936
Mailing Address - Fax:
Practice Address - Street 1:3999 MARINA LAKE RD APT 107
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-2027
Practice Address - Country:US
Practice Address - Phone:585-490-7936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2023060175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine