Provider Demographics
NPI:1760180855
Name:TESSANEKA HILL
Entity Type:Organization
Organization Name:TESSANEKA HILL
Other - Org Name:DAISY'S MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TESSANEKA
Authorized Official - Middle Name:F
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, CIC
Authorized Official - Phone:856-554-0082
Mailing Address - Street 1:2500 BRUNSWICK PIKE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-4134
Mailing Address - Country:US
Mailing Address - Phone:609-875-2520
Mailing Address - Fax:609-875-2521
Practice Address - Street 1:2500 BRUNSWICK PIKE STE 202
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NJ
Practice Address - Zip Code:08648-4134
Practice Address - Country:US
Practice Address - Phone:609-875-2520
Practice Address - Fax:609-875-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1518419449Medicaid