Healthcare Provider Details

I. General information

NPI: 1730098971
Provider Name (Legal Business Name): TANISHA SHARICE AVERY-HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7807 LANDER AVE
HILMAR CA
95324-9398
US

IV. Provider business mailing address

7807 LANDER AVE
HILMAR CA
95324-9398
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-5903
  • Fax: 209-667-7628
Mailing address:
  • Phone: 209-667-5903
  • Fax: 209-667-7628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: