MEDICARE: MS. TANISHA HOLMAN

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	376J00000X	Homemaker	67073601	PA
2	385H00000X	Respite Care	67073601	PA
3	253Z00000X	In Home Supportive Care Agency	67073601	PA

General Provider Information

NPI Number	:	1316665748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TANISHA HOLMAN

Provider Business Mailing Address
First Line	:	4601 FLAT ROCK RD UNIT 24
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2055
Country	:	US
Telephone Number	:	267-325-1567
Fax Number	:

Provider Business Practice Location Address
First Line	:	4601 FLAT ROCK RD UNIT 24
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19127-2055
Country	:	US
Telephone Number	:	267-325-1567
Fax Number	:

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

Provider Enumeration Date	:	08/22/2022
Last Update Date	:	08/22/2022

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