Individual
TACKESHA TANESHA THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
9720 S TACOMA WAY, LAKEWOOD, WA 98499-4456
(253) 304-7753
Mailing address
6811 S 204TH ST, STE 280, KENT, WA 98032-1352
(888) 674-5871
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP61136177
WA
363LF0000X
Family Nurse Practitioner
61136177
WA
Other
Enumeration date
01/20/2021
Last updated
12/17/2021
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