Provider Demographics
NPI:1558874545
Name:BYTHWOOD TISSIERA, FELESHIA (LPN)
Entity Type:Individual
Prefix:
First Name:FELESHIA
Middle Name:
Last Name:BYTHWOOD TISSIERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2608 AVENUE M
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-4159
Mailing Address - Country:US
Mailing Address - Phone:561-352-3192
Mailing Address - Fax:561-842-8557
Practice Address - Street 1:2608 AVENUE M
Practice Address - Street 2:
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404-4159
Practice Address - Country:US
Practice Address - Phone:561-352-3192
Practice Address - Fax:561-842-8557
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN0958431164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse