Healthcare Provider Details

I. General information

NPI: 1700777505
Provider Name (Legal Business Name): TASHA GRATH BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 N BONITA AVE
PANAMA CITY FL
32401-3623
US

IV. Provider business mailing address

6511 HEATHER MARIE LN
PANAMA CITY FL
32404-8310
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-1511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9186637
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: