Provider Demographics
NPI:1447808233
Name:JANSSEN, TASHA MAE (NP-C)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:MAE
Last Name:JANSSEN
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:TASHA
Other - Middle Name:MAE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4711 GOLF RD STE 1250
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1232
Mailing Address - Country:US
Mailing Address - Phone:847-235-6130
Mailing Address - Fax:
Practice Address - Street 1:516 13TH ST
Practice Address - Street 2:
Practice Address - City:WELLMAN
Practice Address - State:IA
Practice Address - Zip Code:52356-9232
Practice Address - Country:US
Practice Address - Phone:319-646-2911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE115158363LF0000X
IL209.030152363LF0000X
IAA135164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily