Provider Demographics
NPI:1447026471
Name:HENDERSON, TASHIA (BSN, RN)
Entity type:Individual
Prefix:
First Name:TASHIA
Middle Name:
Last Name:HENDERSON
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:MISS
Other - First Name:TASHIA
Other - Middle Name:CHANTESE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3266 KAISER DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4555
Mailing Address - Country:US
Mailing Address - Phone:443-695-2491
Mailing Address - Fax:
Practice Address - Street 1:1900 E NORTHERN PKWY STE T6
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2120
Practice Address - Country:US
Practice Address - Phone:443-438-6893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR252616163WC0200X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine