Provider Demographics
NPI:1598532467
Name:WASHINGTON, TAKESHA L
Entity type:Individual
Prefix:
First Name:TAKESHA
Middle Name:L
Last Name:WASHINGTON
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 1:2220 N CYPRESS BEND DR APT 501
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4402
Mailing Address - Country:US
Mailing Address - Phone:305-335-7363
Mailing Address - Fax:
Practice Address - Street 1:2220 N CYPRESS BEND DR APT 501
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4402
Practice Address - Country:US
Practice Address - Phone:305-335-7363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-11
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNPCN-17379-11799246RP1900X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy