Provider Demographics
NPI:1548908775
Name:JACKSON, TA'SHARIE
Entity type:Individual
Prefix:
First Name:TA'SHARIE
Middle Name:
Last Name:JACKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5921 WINDY SANDS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-1897
Mailing Address - Country:US
Mailing Address - Phone:725-256-7153
Mailing Address - Fax:
Practice Address - Street 1:1516 E TROPICANA AVE STE 199
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-8323
Practice Address - Country:US
Practice Address - Phone:725-214-7776
Practice Address - Fax:725-214-7768
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker