Provider Demographics
NPI:1073116455
Name:CARRIDINE, TELISHA (RN)
Entity Type:Individual
Prefix:
First Name:TELISHA
Middle Name:
Last Name:CARRIDINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TELISHA
Other - Middle Name:
Other - Last Name:NETTLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7687 VANDALAY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-8147
Mailing Address - Country:US
Mailing Address - Phone:850-372-3225
Mailing Address - Fax:
Practice Address - Street 1:7687 VANDALAY DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-8147
Practice Address - Country:US
Practice Address - Phone:850-372-3225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9462189163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRN9462189OtherREGISTERED NURSE LICENSE NUMBER