Provider Demographics
NPI:1992499248
Name:EDWARD, TASHIKA (FNP)
Entity type:Individual
Prefix:
First Name:TASHIKA
Middle Name:
Last Name:EDWARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 JESSIE LN
Mailing Address - Street 2:
Mailing Address - City:VACHERIE
Mailing Address - State:LA
Mailing Address - Zip Code:70090-5122
Mailing Address - Country:US
Mailing Address - Phone:225-623-9370
Mailing Address - Fax:
Practice Address - Street 1:115 JESSIE LN
Practice Address - Street 2:
Practice Address - City:VACHERIE
Practice Address - State:LA
Practice Address - Zip Code:70090-5122
Practice Address - Country:US
Practice Address - Phone:225-623-9370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAF06230247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily