MEDICARE: TANISHA CURTIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	473371017	NC

General Provider Information

NPI Number	:	1245617117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANISHA CURTIS

Provider Business Mailing Address
First Line	:	3017 CRYSTAL LAKE DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9558
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3017 CRYSTAL LAKE DR
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-9558
Country	:	US
Telephone Number	:	757-580-2666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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