MEDICARE: TANISHA A JONES BSN, RN, MSN, C-FNP

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	363LP2300X	Primary Care Nurse Practitioner	209010485	IL
2	363LF0000X	Family Nurse Practitioner	209010485	IL
3	363L00000X	Nurse Practitioner	209010485	IL

General Provider Information

NPI Number	:	1568609667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANISHA A JONES BSN, RN, MSN, C-FNP

Provider Business Mailing Address
First Line	:	6501 S PROMONTORY DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-1002
Country	:	US
Telephone Number	:	773-363-6700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 S PROMONTORY DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-1002
Country	:	US
Telephone Number	:	773-363-6700
Fax Number	:

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

Provider Enumeration Date	:	01/11/2009
Last Update Date	:	06/05/2020

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