MEDICARE: MS. TAMISHA LASHAY GANT PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP3762	AZ
2	163W00000X	Registered Nurse	RN164853	AZ
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	23139	CA
4	163W00000X	Registered Nurse	843046	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356642920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TAMISHA LASHAY GANT PMHNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 360039
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30036-0039
Country	:	US
Telephone Number	:	602-704-1020
Fax Number	:	602-704-1020

Provider Business Practice Location Address
First Line	:	2501 N HAYDEN RD STE 103
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-2326
Country	:	US
Telephone Number	:	602-704-1020
Fax Number	:	602-669-4185

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	08/26/2025

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