Provider Demographics
NPI:1033695515
Name:DURBIN, TISHA LUCILLE
Entity Type:Individual
Prefix:MRS
First Name:TISHA
Middle Name:LUCILLE
Last Name:DURBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 N TACOMA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3547
Mailing Address - Country:US
Mailing Address - Phone:317-209-7990
Mailing Address - Fax:
Practice Address - Street 1:4817 N PARKWAY
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-3940
Practice Address - Country:US
Practice Address - Phone:765-271-8207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-17
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator