Healthcare Provider Details

I. General information

NPI: 1356708630
Provider Name (Legal Business Name): TASHA N HUDSON DNP, APRN, AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TASHA HUDSON HAVINS

II. Dates (important events)

Enumeration Date: 01/18/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 LANSDOWNE ST
DETROIT MI
48224-1045
US

IV. Provider business mailing address

12201 LANSDOWNE ST
DETROIT MI
48224-1045
US

V. Phone/Fax

Practice location:
  • Phone: 682-305-5288
  • Fax:
Mailing address:
  • Phone: 682-305-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4704382539
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704382539
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number4704382539
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: