Healthcare Provider Details

I. General information

NPI: 1588552467
Provider Name (Legal Business Name): TASHEMA MONIQUE LOVE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2025
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 ARBOR CROWNE DR
LAWRENCEVILLE GA
30045-7300
US

IV. Provider business mailing address

89 ARBOR CROWNE DR
LAWRENCEVILLE GA
30045-7300
US

V. Phone/Fax

Practice location:
  • Phone: 770-876-1427
  • Fax: 770-876-1427
Mailing address:
  • Phone: 678-310-5507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN259821
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: