Provider Demographics
NPI:1598513236
Name:DEVERICKS-RECALDE, TASHA
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:DEVERICKS-RECALDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4847 DAVID S MACK DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-8023
Mailing Address - Country:US
Mailing Address - Phone:561-868-6573
Mailing Address - Fax:
Practice Address - Street 1:4847 DAVID S MACK DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-8023
Practice Address - Country:US
Practice Address - Phone:561-868-6573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017682363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner