Provider Demographics
NPI:1164665543
Name:AUGUSTUS-TOLBERT, TISHA (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:TISHA
Middle Name:
Last Name:AUGUSTUS-TOLBERT
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 TURNERSBURG HWY
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-2798
Mailing Address - Country:US
Mailing Address - Phone:704-878-5300
Mailing Address - Fax:704-878-5311
Practice Address - Street 1:318 TURNERSBURG HWY
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-2798
Practice Address - Country:US
Practice Address - Phone:704-878-5300
Practice Address - Fax:704-878-5311
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC217532163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse