Provider Demographics
NPI:1679459929
Name:TAYLOR, TASHANA MARIE (L-CSFA)
Entity type:Individual
Prefix:MISS
First Name:TASHANA
Middle Name:MARIE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:L-CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17318 MARY ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:VA
Mailing Address - Zip Code:22427-2739
Mailing Address - Country:US
Mailing Address - Phone:804-867-8322
Mailing Address - Fax:804-867-8322
Practice Address - Street 1:17318 MARY ADAMS AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-2739
Practice Address - Country:US
Practice Address - Phone:804-867-8322
Practice Address - Fax:804-867-8322
Is Sole Proprietor?:No
Enumeration Date:2025-08-13
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0136000366246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant