Provider Demographics
NPI:1962913442
Name:PRESCOTT, TA-TANISHA (RN, BSHA)
Entity type:Individual
Prefix:MS
First Name:TA-TANISHA
Middle Name:
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:RN, BSHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 TOWN SQUARE PL
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94603-3173
Mailing Address - Country:US
Mailing Address - Phone:510-798-9654
Mailing Address - Fax:
Practice Address - Street 1:3 TOWN SQUARE PL
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94603-3173
Practice Address - Country:US
Practice Address - Phone:510-798-9654
Practice Address - Fax:510-798-9654
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95067832163WA2000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator