Provider Demographics
NPI:1871953489
Name:BROOKS, TASHA (CNA)
Entity type:Individual
Prefix:MISS
First Name:TASHA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7704 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3062
Mailing Address - Country:US
Mailing Address - Phone:402-819-8786
Mailing Address - Fax:
Practice Address - Street 1:7704 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3062
Practice Address - Country:US
Practice Address - Phone:402-819-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE77465374700000X
NE24601376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No376K00000XNursing Service Related ProvidersNurse's Aide