Healthcare Provider Details

I. General information

NPI: 1487435376
Provider Name (Legal Business Name): TAJE USHER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2023
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1729 WILDWOOD DR STE 103
VIRGINIA BEACH VA
23454-3176
US

IV. Provider business mailing address

3999 MARINA LAKE RD APT 107
VIRGINIA BEACH VA
23452-2027
US

V. Phone/Fax

Practice location:
  • Phone: 757-938-3654
  • Fax: 757-938-3658
Mailing address:
  • Phone: 585-490-7936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0024188699
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number0024188699
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024188699
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: