MEDICARE: MISS TASHANA MARIE TAYLOR L-CSFA

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	246ZC0007X	Surgical Assistant	0136000366	VA

General Provider Information

NPI Number	:	1679459929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TASHANA MARIE TAYLOR L-CSFA

Provider Business Mailing Address
First Line	:	17318 MARY ADAMS AVE
Second Line	:
City	:	BOWLING GREEN
State	:	VA
Zip	:	22427-2739
Country	:	US
Telephone Number	:	804-867-8322
Fax Number	:	804-867-8322

Provider Business Practice Location Address
First Line	:	17318 MARY ADAMS AVE
Second Line	:
City	:	BOWLING GREEN
State	:	VA
Zip	:	22427-2739
Country	:	US
Telephone Number	:	804-867-8322
Fax Number	:	804-867-8322

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

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	08/13/2025

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