Provider Demographics
NPI:1598348799
Name:ON-SITE HEALTH LLC
Entity Type:Organization
Organization Name:ON-SITE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:TISDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C
Authorized Official - Phone:228-669-4505
Mailing Address - Street 1:10 CANEBRAKE BLVD STE 110-09
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-2211
Mailing Address - Country:US
Mailing Address - Phone:601-724-9222
Mailing Address - Fax:
Practice Address - Street 1:10 CANEBRAKE BLVD STE 110-09
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-2211
Practice Address - Country:US
Practice Address - Phone:769-333-8808
Practice Address - Fax:769-333-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty