Provider Demographics
NPI:1861642480
Name:FUJINO, TISHA SAORI (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TISHA
Middle Name:SAORI
Last Name:FUJINO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:TISHA
Other - Middle Name:SAORI
Other - Last Name:MURAOKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:6670 S. TENAYA WAY #180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113
Mailing Address - Country:US
Mailing Address - Phone:702-369-4999
Mailing Address - Fax:702-369-2993
Practice Address - Street 1:6670 S. TENAYA WAY #180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113
Practice Address - Country:US
Practice Address - Phone:702-369-4999
Practice Address - Fax:702-369-2993
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001019363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV35199OtherMEDICARE GROUP NUMBER