Healthcare Provider Details

I. General information

NPI: 1124911821
Provider Name (Legal Business Name): TAHISHA JEAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2025
Last Update Date: 05/31/2025
Certification Date: 05/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 POTTERSVILLE RD
CHESTER NJ
07930-2432
US

IV. Provider business mailing address

3 JEAN ST # A2
MORRISTOWN NJ
07960-2841
US

V. Phone/Fax

Practice location:
  • Phone: 908-895-4931
  • Fax:
Mailing address:
  • Phone: 908-884-4628
  • Fax: 908-884-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number26NR20500400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: