MEDICARE: TASHA WILCOX

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	163W00000X	Registered Nurse	820916	CA

General Provider Information

NPI Number	:	1356774244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TASHA WILCOX

Provider Business Mailing Address
First Line	:	PSC 477 BOX 170
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96306-0100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 477
Second Line	:	BOX 170
City	:	FPO
State	:	AP
Zip	:	96306-0002
Country	:	US
Telephone Number	:	08042335529
Fax Number	:

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

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	08/14/2013

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Directions to “ TASHA WILCOX ” Practice Location

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