MEDICARE: TANISHA THOMAS

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1639714512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANISHA THOMAS

Provider Business Mailing Address
First Line	:	828 CAMDEN YARD CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4777
Country	:	US
Telephone Number	:	225-439-3823
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 CAMDEN YARD CT
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-4777
Country	:	US
Telephone Number	:	225-439-3823
Fax Number	:

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

Provider Enumeration Date	:	11/14/2019
Last Update Date	:	11/14/2019

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Directions to “ TANISHA THOMAS ” Practice Location

Language	Start Address	Practice Location

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