MEDICARE: MS. TONIA PATRICE TASH FNP-BC

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	164W00000X	Licensed Practical Nurse	PR37593	SC
2	363LF0000X	Family Nurse Practitioner	25008	SC

General Provider Information

NPI Number	:	1548696008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TONIA PATRICE TASH FNP-BC

Provider Business Mailing Address
First Line	:	4711 FOREST DR STE 3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-3125
Country	:	US
Telephone Number	:	803-821-8333
Fax Number	:	864-751-5834

Provider Business Practice Location Address
First Line	:	4711 FOREST DR STE 3
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29206-3125
Country	:	US
Telephone Number	:	803-821-8333
Fax Number	:	864-751-5834

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	07/19/2021

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