Provider Demographics
NPI:1154852283
Name:SIMS, TI'SHEA
Entity Type:Individual
Prefix:DR
First Name:TI'SHEA
Middle Name:
Last Name:SIMS
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 1:4067 LAGNIAPPE WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-1201
Mailing Address - Country:US
Mailing Address - Phone:850-219-2509
Mailing Address - Fax:850-219-2506
Practice Address - Street 1:4067 LAGNIAPPE WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-1201
Practice Address - Country:US
Practice Address - Phone:850-219-2509
Practice Address - Fax:850-219-2506
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51655183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist