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Individual

TASHA MARIE TYCE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1218 N ADAMS ST, SOUTH BEND, IN 46628-3021
(574) 217-6214
Mailing address
1218 N ADAMS ST, SOUTH BEND, IN 46628-3021
(574) 217-6214

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
71656
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
30037597
IN
Enumeration date
05/30/2020
Last updated
05/30/2020
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