Provider Demographics
NPI:1942824768
Name:TISDALE, LEONORA C (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:LEONORA
Middle Name:C
Last Name:TISDALE
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N MEDICAL DRIVE UNC-CH SON: CARRINGTON HALL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7460
Mailing Address - Country:US
Mailing Address - Phone:919-966-4260
Mailing Address - Fax:
Practice Address - Street 1:3600 NW CARY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-8444
Practice Address - Country:US
Practice Address - Phone:919-319-9219
Practice Address - Fax:919-481-1716
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC270439390200000X
NCTISD-7K5PK363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program