Provider Demographics
NPI:1578326187
Name:TISDALE, TYKEILA IESHIA (BSHA, MHA, CD)
Entity Type:Individual
Prefix:
First Name:TYKEILA
Middle Name:IESHIA
Last Name:TISDALE
Suffix:
Gender:F
Credentials:BSHA, MHA, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 HOUND CHASE DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-5422
Mailing Address - Country:US
Mailing Address - Phone:813-399-4833
Mailing Address - Fax:
Practice Address - Street 1:9980 HOUND CHASE DR
Practice Address - Street 2:
Practice Address - City:GIBSONTON
Practice Address - State:FL
Practice Address - Zip Code:33534-5422
Practice Address - Country:US
Practice Address - Phone:813-399-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174400000XOther Service ProvidersSpecialist