Healthcare Provider Details

I. General information

NPI: 1992662290
Provider Name (Legal Business Name): TANISHA GISELE JARRETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6773 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

IV. Provider business mailing address

6773 W MAPLE RD
WEST BLOOMFIELD MI
48322-3013
US

V. Phone/Fax

Practice location:
  • Phone: 313-588-9322
  • Fax:
Mailing address:
  • Phone: 313-588-9322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704322412
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704322412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: