Provider Demographics
NPI:1376910034
Name:BREWINGTON, TISHIRA (PA-C)
Entity Type:Individual
Prefix:
First Name:TISHIRA
Middle Name:
Last Name:BREWINGTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 STONY FALLS WAY
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-5132
Mailing Address - Country:US
Mailing Address - Phone:678-478-0588
Mailing Address - Fax:
Practice Address - Street 1:781 AVENT FERRY RD STE 310
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7776
Practice Address - Country:US
Practice Address - Phone:919-552-8911
Practice Address - Fax:919-552-8955
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant